I think the point is being missed. The question isn't how long are people waiting in A&E, the question is it true that the government are lying about waiting times.
Stevextc claims that they are, and that helps to explain vaccine conspiracy theories.
According to my link above "on the day NHS England released its latest monthly data for hospital performance."
So NHS England appears to be readily accepting that the targets are not being met.
I can't understand why that provides a good example of why we might have vaccine hesitation.
This was the easiest one to find, but we've had critical incidents here at East Midlands hospitals in the last 2-3 months as well.
BBC News - Royal Cornwall Hospitals Trust declares critical incident
https://www.bbc.co.uk/news/uk-england-cornwall-58996914
Del
Full MemberActually now I think about it wasn’t it covered quite widely a couple of weeks ago that these targets were being massively missed?
Yep, in fact the target hadn't been for everyone to be seen/treated within 4 hours for a long time- it was for 95% to be seen and treated within 4 hours.
It was scrapped this year- the government said "“We will be judged by the right targets. Targets have to be clinically appropriate.” and it was definitely not because it'd been missed for over 60 months in a row and had just had the worst result of all time.
Hey, did something change in 2010?
I've been working for nearly 20 years in the NHS, at different times managing services to the 4-hour A&E and various elective, cancer targets etc. I have worked as a senior manager in finance, operations, performance, planning, strategy and various other bits - basically all of it. I am not strictly a numbers person but I have experience of putting the numbers together in all four UK home countries. In my current role, my team is in touch with all the critical care and EDs in the UK.
I have only briefly read this last page and don't have the time to look back. But one of the reasons for giving up is just how sad it is to read of people genuinely believing that the things I work on every day aren't real - that A&E numbers are massaged etc. They aren't! The words and numbers I write are out there... they form part of all the publicly available information, reports, data etc. They are real and aren't taken away to have stuff done to them by some faceless NHS data demon.
I think the population at large think that the NHS is one big organisation with a command structure like Tesco or the army. It isn't. It's basically a common funding arrangement for hundreds of different organisations, who are part of the same industry but have to plan and deliver safety measures, quality indicators and so on in a local / regional / devolved national context.
This grouping just isn't capable of massaging numbers or doing the bad stuff that is being imagined. I don't doubt from my experience that some critical edge cases are (not) included in datasets, but if you think the NHS or wider government has the capability for systematic manipulation or misrepresentation of data in the NHS then you are in for a really big disappointment.
Thank’s for that post Ben.
The person I know who was ranting about masks being torture for a fake Covid never expressed any previous interest in 5G or chem trails… now they are all integrated into his anti-covid rant with a Great reset where basically Bill Gates manufactured covid so we could all be “vaccinated” with 5G chips that somehow get “activated” by chem trails…
I think you’ll find that this is known as the ‘Facebook and social media effect’, because it’s quite clear that those who subscribe to these sort of notions are almost always frequent users of said media platforms, and as has been published over the last few days has shown, Facebook in particular has to all intents and purposes encouraged the proliferation of such falsehoods.
My cousin started posting up bullshit conspiracy stuff about ’chemtrails’ a few years back, which had me responding with well researched articles about the subject, along with photos takes of the skies over London during WW2, showing it full of contrails/vapour-trails, well before the introduction of jet aircraft. Also a quote by a famous French writer describing his aircraft leaving behind contrails like lacy scarves, that would expand into cirrus clouds, and that was in 1939! I’m not entirely sure she was convinced; I pretty much stopped using Facebook around that time.
A lot has been said about so little.
This thread left its URL some time ago when it got serious.
With all due respect - i mean, tbf most people would let 'adorn' just wash over them - can we get back to the discussion of the Coronavirus pandemic?
It ain't not gone nowhere.
I’ve been working for nearly 20 years in the NHS, at different times managing services to the 4-hour A&E and various elective, cancer targets etc. I have worked as a senior manager in finance, operations, performance, planning, strategy and various other bits – basically all of it.
"most" senior NHS managers are so detached from what's actually happening on a ground level they may as well work in a different industry
9-5 in a 200 capacity car park, you cannot get parked, pop in at a weekend/after 5 pm, choose 170/180 parking spaces, the NHS has so many levels of management, so many levels that have been sideways moved into "new" jobs its embarrassing
From my work in the charity sector I was astonished at the levels of adult illiteracy and innumeracy in the country.
Would never have guessed! It also comes with some very good coping strategies, people hide it well as it is very embarrassing.
https://www.wbs.ac.uk/news/how-many-managers-does-the-uk-s-nhs-need/
https://www.kingsfund.org.uk/projects/health-and-social-care-bill/mythbusters/nhs-managers
Dirtyrider - please verify what you are saying. I want to see the evidence - HSJ, McKinsey industry analysis type-of-thing.
What I can see says that NHS management is about one third of the sorts of levels expected by wider sector standards. More generally, the NHS system costs about a half of what it would cost to administer an insurance-type system.
I get it that the NHS is common experience for people in the way that, say, supermarket shopping is. Nonetheless, we seem to have a deeper and more strongly-held set of views to share when it comes to the NHS than any other industry I can think of.
Del
Steve, start your own thread on this please. I have no issue with you asking questions but you are IMO derailing this thread.
What I will say in response to you is that we’re at ~ 90% of the adult population double jabbed. Admittedly according to .gov figures. If anti vax was a massive problem we wouldn’t be where we are.
It's a fair point with the current variants and with Covid.
What worries me more is the vaccine resistant variant at some point or the next pathogen that makes Covid look like a relatively pleasant one.
I mean it's 2021 and we all forgot about Y2K ... to the point where it's quite popular to make the it out to be a fake/conspiracy.
Well, there are plenty of things to worry about in this day and age. My friend's mother, in her 80s has dementia and is frequently sitting in her own waste, naked, with her front door open. There's no help forthcoming from the state. I won't pretend there hasn't been a long path between here and there but that's where she is right now. My friend's only option left is to call non emergency police for a safety check and hope she gets sectioned. 2021 Britain. Go us. 😟
It’s new to me. I’ve never heard of anyone waiting 8 hours before being seen in A&E. I’m not claiming it has never happened but I doubt that it is a routine occurance.
Stuff happens. Sometimes a car journey that should take 15 minutes takes 2 hours.
....
Edit : I’ve just checked and it appears that 4 hours is the target. I can only assume anyone who waits 8 hours, for whatever unexpected reason, isn’t considered urgent.
It's now simply a target ... Obviously not one being hit if you simply search google
https://www.dailyrecord.co.uk/news/scottish-news/patients-face-40-hour-wait-25315300
https://www.dailyrecord.co.uk/news/politics/scotland-records-worst-ae-waiting-25195758
(I have no reason to think England is better but that's just what google found)
What is more important for trust is HOW it went from being a stated fact to a target.
Or perhaps why does the daily record have a thing about it?
It seems to me it changed because so many people simply didn't believe it due to their own experiences. Obviously at some point some hospital would have some reporter who waited much longer than 4 hours only to be told "no you didn't because we see ALL people in 4"? Maybe one of them worked for the Daily Record?
I would have thought that you might have come up with a better example of governments lying.
Well, lies don't need to be "exciting" to shatter people's trust.
First point is this isn't the government ... governments come and go... but the NHS is many things but not a 'part of government'. (IMHO thankfully)
I think most people expect our government to lie to the electorate in many degrees, certainly not take what they say as "true"... it's all part and parcel of "democracy" and if we don't like the lying we can elect another set (or not).
The Government/Cabinet/Ministers aren't meant to lie to the house of parliament ... or in international treaties etc. but they are held to a different standard than something like the NHS by most people. Most people don't really believe a lot of "claims" and so long as the claims are debateable in some way they tend to get away with it. (i.e. claiming a reduction in pay freeze is a pay increase)
Obviously these are in a different league with the current government but that's politics as it were. (A whopper being we aren't trying to sell off the NHS for example or "there are no press here"). It almost seems like they are competing to tell for most barefaced lie at times in some interpersonal competition???
Strictly speaking the different hospitals, trusts etc. aren't "The NHS" either but they are part of a collection of what many see as "trusted organisations" that are meant to be funded through but independent of government. Most people expect for example that if they go to a doctor that the doctor is truthful, not economic with the truth or just a barefaced lie.
Technically your GP is part of a independent business (sort of) etc. and we have gone through countless iterations of healthcare trusts etc. but ultimately in the "national psyche" these are all a part of a wider NHS.
Actually Ben_H sums it up..
I think the population at large think that the NHS is one big organisation with a command structure like Tesco or the army. It isn’t. It’s basically a common funding arrangement for hundreds of different organisations, who are part of the same industry but have to plan and deliver safety measures, quality indicators and so on in a local / regional / devolved national context.
I have only briefly read this last page and don’t have the time to look back. But one of the reasons for giving up is just how sad it is to read of people genuinely believing that the things I work on every day aren’t real – that A&E numbers are massaged etc. They aren’t! The words and numbers I write are out there… they form part of all the publicly available information, reports, data etc. They are real and aren’t taken away to have stuff done to them by some faceless NHS data demon.
I'm not disbelieving you in terms of today .. this example was a decade ago (it just happens to be my personal experience) and there have been countless restructures and I don't know what else changed in between.
The important thing is this is a contributing factor to MY personal distrust of facts from the "collection of the NHS".
It was only ever intended as a personal example because that is why I think it is so important that 'organisations associated with the NHS' are squeaky clean and use precise language. People experience a few things like this and their implicit trust is gone.
Much as I hate this government and their handling of the pandemic, I’m not sure we can pin this new variant on Boris just yet.
Whilst not sure about the source of AY.4, the rate of production of new variants is proportional to the number of infections. That’s how mutation works. We’ve been running with a much higher infection rate that most countries (4x higher that European mean). From a selection perspective, Darwin doesn’t care if you are two years old or ninety. Ok you may do less well if you are old, but that two year old with asymptomatic infection can still generate mutants that can be spread.
Delta Plus is only a little more transmissible, and probably not more pathogenic. In fact Delta doesn’t look that differ to Alpha in that regard.
But a recent outbreak of Delta reported in an Italian nursing home, with 90% resident and 81% staff double vaccinated was chilling. 12% of all residents died. Now propagate that through the U.K. nursing home sector and you can see why boosters are being urged.
What is more important for trust is HOW it went from being a stated fact to a target.
Its always been the bloody target!
the rate of production of new variants is proportional to the number of infections. That’s how mutation works. We’ve been running with a much higher infection rate that most countries
Now I'm happy to pin it on Boris!👍
I never thought I’d miss Hunt. The first stages of the pandemic made that happen. I never thought I’d miss Hancock. This stage of the pandemic has almost made that happen.
This summer and autumn have been a mess, and the result will be a worse winter and spring, not just for us, but for other nations as well, because of the choices made by our government. Still, we can cheer them on as they snub the dastardly French as they offer to deescalate arguments over fish. Rule Britannia, let the hospital beds fill up, keep the cremation fires burning, export another UK made variant to keep our lesser neighbours on their toes.
This summer and autumn have been a mess, and the result will be a worse winter and spring, not just for us, but for other nations as well, because of the choices made by our government. Still, we can cheer them on as they snub the dastardly French as they offer to deescalate arguments over fish. Rule Britannia, let the hospital beds fill up, keep the cremation fires burning, export another UK made variant to keep our lesser neighbours on their toes.
While I'm no fan of the government, I'm not quite at this level of doom mongering self flagelation - yet. Things could and should have been done better, but I'm not (yet) seeing the same level of disruption to my daughters school or my son's university* as we saw last year, and I hope and believe that the vaccine and boosters will reduce the impact of the virus this winter.
Proper rules on hands, face, space would obviously help though, rather than blindly ploughing on relying on common sense that isn't that common.
*though the uni are apparently expecting an increase in Covid cases on the back of lots of family/home visits in this last half term week. Not helped by a high proportion of the supposedly brightest young people not complying with the unis testing protocols.
Just been reading a non-maths book on calculus (haven't used it since my Mech Eng degree, I went the computers route). One of the interesting examples was Ho and Perelson's work on HIV, showing that there wasn't a dormant state after initial illness and that the 2nd phase "pause" was the immune system fighting the virus to a standstill. The rate of replication was such that the virus could plausibly evolve to escape any drug. This understanding allowed the development of triple drug therapies as the chance of any mutant escaping three different drugs with three different ways of working was 1 in 10 million.
Given the ONS statistics showing 2% infection in England there's roughly a million people in England with COVID so no surprise we're working through the possible mutations.
Of course, the rest of the world as a whole has a higher absolute number of cases so if "we" don't "invent" the next variant, someone else will. So keeping infections down world wide and delaying cases so that more people can be vaccinated is key. Hopefully, we'll see more regional and national vaccine production in the future, such as that being set up in South Africa, Egypt and Brazil.
I’m not (yet) seeing the same level of disruption to my daughters school or my son’s university
They are lucky.
In the past few weeks.. year 11 (GCSE)...
- History trip cancelled (not rescheduled) despite being required for a final exam question.
- Triple science completely dropped, for all pupils.
- Every child I know through mine has had several weeks out of the school, in their final year.
Not going great in Calderdale.
Of course, the rest of the world as a whole has a higher absolute number of cases so if “we” don’t “invent” the next variant, someone else will.
Very true. The poorer countries have valid excuses (IMHO) if failing and inflicting harder to deal with variants on the others though... what's our excuse?
– History trip cancelled (not rescheduled) despite being required for a final exam question.
– Triple science completely dropped, for all pupils.
– Every child I know through mine has had several weeks out of the school, in their final year.
Jeez, that's bad. So far only a week off for daughter and most of her Year 10 friends, and that's pretty much the same across all school years. No trips scheduled till after Feb half term anyway - she's due to go to CERN next June.
Her school have been pretty strict with masks though, as Covid ripped through the school September/early October. Might have helped a little.
Of course, the rest of the world as a whole has a higher absolute number of cases so if “we” don’t “invent” the next variant, someone else will.
But the unvaccinated world is less likely to "invent" a vaccine resistant varriant. The problem with Delta and Delta + is that they significantly reduced the effectiveness of vaccines in preventing transmission. High levels of virus in a vaccinated population is more likely to selectively favour vaccine resistant variants.
Good point Edukator, I hadn't considered that
Here I go.
Weekend away with 14 kids. Despite LF tests x2 for all going and caution, one of the kids is positive.
I've been pinged and have a headache...
For info, my LFTs were still -ve for 2 days post +ve PCR test, and 1 day after symptom onset.
Sooo Freester JR brought the 'au naturel booster' home from school a few weeks back. We were all isolating for half term. He was allowed out one week ago, myself and Mrs F completed our 10 days at the weekend.
Freester JR had a negative LFT on Sunday before returning to school, LFT tonight is positive, real strong line on one we did another to be certain and it's positive just a bit fainter.
I'm gutted for him. We're doing the right thing and going through the whole take him out of school after 3 just days get him a PCR etc etc but certain that will be positive.
We were tempted to not front up this time. He's completely asymptomatic. But we're doing the right thing and following the guidelines. Makes me wonder how many don't if we were tempted tho...
Are you saying he had Covid 3 weeks ago and tested positive again today? I don't think you are supposed to test again for 6 weeks as they can still show positive for a while after you are no longer infected.
Yes that's exactly what I am saying. I've scoured the Gov website if there is some guidance please point me to it.
I found no time limits after Covid as far as lateral flow tests are concerned.
My interpretation of the vague instructions is there is no time limit.
There is various guidance by different organisations where some recommend don't LFT for 90 days. Others say test as soon as isolation is over. This was the request we had from school.
Testing after your isolation period has ended
If you have tested positive by PCR for COVID-19, you will probably have developed some immunity to the disease. However, it cannot be guaranteed that everyone will develop immunity, or how long it will last. It is possible for PCR tests to remain positive for some time after COVID-19 infection.Anyone who has previously received a positive COVID-19 PCR test result should not be re-tested within 90 days of that test, unless they develop any new symptoms of COVID-19.
If, however, you do have an LFD antigen test within 90 days of a previous positive COVID-19 PCR test, for example as part of a workplace or community testing programme, and the result of this test is positive, you and your household should self-isolate and follow the steps in this guidance again.
If it is more than 90 days since you tested positive by PCR for COVID-19, and you have new symptoms of COVID-19, or a positive LFD antigen or PCR test, follow the steps in this guidance again.
Just spoke to a rather nice lady on the test and trace line (119).
Her advice was anyone who has previously tested positive should not carry any further PCR or LFD tests for 90 days. As both (LFD less likely) may show a positive result.
What a shit show. Where is that advice on the Gov website. FS.
That LFT advice still sounds wrong… the two members of my house who have had covid recently still need to do regular LFT to attend their schools (teacher and pupil), and they keep being negative. No PCR test within 90 days of a positive PCR test is the only advice I know of as regards retesting.
I think this whole 90 day thing is clear as mud.
The lady on the phone line actually put me on hold and consulted her supervisor to double check and confirmed it was for both LFD and PCR tests.
Just got home from face to face parents evening including parents of kids currently "isolating" due to having covid, one also bought along the brother just to increase the odds a bit more!!
Naughty CRO and possibly Pfizer
Interesting report in the BMJ about data integrity issues at a cro in texas working for pfizer on the vaccine.
Will be interesting if we ever get the timeliness of what pfizer knew and when in relation to the EUA filing
That LFT advice still sounds wrong… the two members of my house who have had covid recently still need to do regular LFT to attend their schools (teacher and pupil), and they keep being negative. No PCR test within 90 days of a positive PCR test is the only advice I know of as regards retesting.
If you test positive on a PCR you are told not to do any test again for 90 days - written guidance isn't clear but that is what you are told.
Jnr tested positive at the end of August, won't be testing again till end of November. His uni are doing weekly PCR testing and they are obviously happy with what he's doing/been told.
Naughty CRO and possibly Pfizer
Interesting report in the BMJ about data integrity issues at a cro in texas working for pfizer on the vaccine.
Will be interesting if we ever get the timeliness of what pfizer knew and when in relation to the EUA filing
They are an SMO (being generous) or a site network (more accurate), certainly not a CRO. Looks like they were running 3 study sites in Texas.
What they are reporting at these 3 sites is not particularly scandalous (even though it's written in the article like it is) - these are all fairly commonplace errors/issues.
Don't get me wrong, you'd shut the site down/remove the data from analysis and never use them again, but on a really large study like this, you would usually have at least one site (usually in the US or Latin America) that's a complete basket case. I'd like to know whether the actual CRO running the study detected these errors and excluded the data. It's hard to say from the article, but a few of these issues should have been self-evident in the data itself.
The real story here is that there was a whistleblower report to the FDA, and then they didn't act on it.
I've had plenty of interaction with FDA clinical trial auditors over the years - and always found their way of working to be fundamentally flawed - in particular, it doesn't scale very well.
Unfortunately, antivaxxers/conspiracy theorists are going to have a field day with this, as it sounds bad, but (at the study level) it really not. FDA are going to have to answer some pretty pointed questions though - they really should have audited these sites after receiving the whistleblower report, or at least included them in the sites selected for Audit (this is what would usually happen). No doubt people will point to the evil hand of big-pharma - but this is probably just down to a cock-up/incompetence/understaffing at the FDA.
Just spoke to a rather nice lady on the test and trace line (119).
Her advice was anyone who has previously tested positive should not carry any further PCR or LFD tests for 90 days. As both (LFD less likely) may show a positive result.
What a shit show. Where is that advice on the Gov website. FS.
When you book a PCR test via the website you are asked about your initial jabs. Sadly booster jabs are not mentioned so we are getting loads of people turning up with booked tests because of their positive LFDs a few days after the booster.
S4 in high school decimated this week, actually probably more than 1in 10, was sent a establishment wide "you're at high risk letter".
Period 4 yesterday a kid was found in neighbouring class who was on register as off (COVID code) as they had PCR positive test but came in anyway.
Points for the correct use of decimated
written guidance isn’t clear but that is what you are told
It wasn’t what we were told when we had our PCR tests.
The new advice issued to care homes is clear though:
Care Home
COVID-19
Testing Guidance
For testing of staff and residents
September 2021
The 90-day window after a positive test
Following a substantial clinical review of the latest evidence and testing data, we are now changing the advice for retesting within 90 days of a positive.
From now on, if someone tests positive with a PCR test, they should not be tested using PCR or Rapid lateral flow for 90 days, unless they develop new symptoms during this time, in which case they should be retested immediately using PCR. This 90 day period is from the initial onset of symptoms or, if asymptomatic when tested, their positive test result.
The previous policy to continue Rapid lateral flow testing following a positive PCR result was because although very unlikely, it is possible to be reinfected within 90 days. However based on the latest testing data and clinical advice, the policy has now changed.
The clinical view is that during this 90 day window from a positive test, given the low rate of reinfection during this window it is signifcantly more likely that a positive Rapid lateral flow test would be a false result, rather than someone being reinfected, causing people to isolate unnecessarily. Therefore we are now stopping the regular testing using Rapid lateral flow during this 90 day period. The individual should return to the regular Rapid lateral fow and PCR regime once 90 days has passed.
That’s all I can find. If the same advice is supposed to be issued to the public (and workplaces and schools etc), can anyone find where it is published? Given the staffing crisis in care homes, the advice might not be the same for other sectors. If it is, we need to see it published so that workplace and education rules can we adjusted to account for that.
Batfink - agreed, none of that is unusual as findings of both cro's and sites. The scale however is a bit eye opening, potential unblinding of that number and an unknown level of qc and di issues is above a level that you would expect. I would expect that to have been reported both to the site leadership, overseeing cro and sponsor as potentially critical issues with onward comms to the fda.
Either way someone has questions to answer, the cro and sponsor have to be aware of this. Like i said would be interesting to find out timelines as it wouldn't be the first time that a company has delayed reporting bad news on data to ensure there is no disruption to a filing or approval
Interesting about the 90 day guidance changing to include lfts now. When I had my pos PCR at the end of July I was clearly told not to do another PCR for 90 days but no mention of lft.
Out of interest I did a few more lfts and it became more strongly positive then went negative by about day 9.
As it happens I got a fever and headache last week exactly 91 days after the positive test so did another lft and PCR. Both were negative.
Spoke to a patient recently who seems to be forced to pay for a pre travel PCR in a few days despite being less than 90 days after her positive PCR. Not sure whether the travel industry understands this part of the science at all. She is bricking it in case it’s still positive.
Interesting also when I arranged the PCR last week I was offered an optional blood spot antibody test 2 weeks after. That seems new.
the cro and sponsor have to be aware of this
Not necessarily - some of what the article describes would be self evident, but stuff like the potential for unblinding wouldn’t necessarily be - a lot depends on to what extent the site went to hide the issues from the CRO (who I work for, btw).
We were offered the antibody test as well. They haven’t arrived yet though.
Sorry i wasn't clear. I would expect the governance and oversight to have identified the risk factors here to trigger a greater scrutiny.
I appreciate that it could have been concealed which depending on the contracts and msa could indicate fraud etc.
I compelling understand that during the pandemic and the massive scale up that occurred during the vaccine studies these things could be missed but still. I'm a GCP auditor (For disclosure)
I’m a GCP auditor
Lol.
It will be interesting to see how the “risk based monitoring” fared here - but I suspect there was a significant effort by the site to conceal the issues, and I wonder whether this crosses the line into fraud.
I’m afraid I the only thing I distrust more than risk based monitoring, are American commercial sites
