Hancock’s Half Hour

Having just published Cobra, a nuclear farce, precisely half of which takes place within the confines of Cabinet Office Briefing Room A, I was interested to hear Dominic Cummings’ account of a “surreal” Cobra meeting, convened to discuss the pandemic, interrupted by a request from President Trump allegedly that the UK bomb Iraq, and further interrupted by the PM’s girlfriend (now wife, heartiest congratulations to them both), exercised about some tabloid tittle-tattle concerning the family pet.  You wouldn’t make it up!  Well, I suppose in a way I did. Prescience, or mere serendipity?  You decide. 

I can’t say I listened to more than the recorded highlights of Mr Cumming’s seven hours before the combined Select Committees, but if he had a good word to say about anybody in government, the civil service, or the scientific community, I didn’t hear it.  He saved his most bitter vitriol for the health secretary Matt Hancock, who was said to be economical with the truth, and who ought, apparently, to have been sacked 15 or 20 times.  The entire picture was one of a dysfunctional establishment, failing to comprehend the enormity of the impending catastrophe, failing to come up with a coherent plan, yet insisting that such a plan had indeed been put into effect.

Mr Hancock had to respond to all this in parliament the following day.  I should say that I’m not a great fan of Mr Hancock, principally because of his enthusiasm for remote consultation in general practice, which he advocates ought to be the norm.  To me, that is, frankly, anathema.  Even so, when I listened to his statement to the House, I could not but help admire his grace under pressure.  He was calm, measured, articulate, and reasonable.  Whether or not his defence of his own actions throughout the pandemic will be vindicated by any subsequent Inquiry remains to be seen. 

One of the more contentious issues about the government response to the crisis relates to the freeing up of hospital beds to give hospitals capacity to cope with the anticipated surge of admissions.  As we now know, patients, Covid status unknown, mostly elderly, were discharged to care homes, with disastrous consequences. 

I think this tells us a lot about the way the UK works.  You get a directive from the powers that be, and you enact it.  Yet we should pause to consider the issue of hospital discharge.  In medical parlance this is termed “disposition”.  You can readily see why the more familiar term “disposal” is not used (even if in this context it might seem more appropriate).  Now disposition is a clinical decision.  It comes at the end of a litany of decisions as follows: diagnosis, formulation, treatment, disposition.  (“Formulation”, a diagnostic construct apprehending how the diagnosis pertains to the patient’s unique set of circumstances, is a concept normally reserved to psychiatry.  Yet every consultation contains a psychiatric element.)  With respect to an individual patient, nobody would expect the Health Secretary to make the diagnosis, far less organise the “management plan”, or treatment.  And yet, it appears, the government are prepared to dictate the disposition.  When the consultants were instructed to send their patients home, should they not have paused to consider whether, in each individual case, such a disposition was advisable, and if they thought otherwise, should they not have put their foot down?   

New Zealand has done very well throughout the pandemic, thus far.  (Thus far- you always need to add that rider.)  As a New Zealand citizen, I believe that the reason NZ did vastly better than the UK relates to the relationship between the politicians and the healthcare professionals.  When I was Clinical Head of the Department of Emergency Medicine in Middlemore Hospital, South Auckland, the then Minister of Health, subsequently Prime Minister, Bill English, visited the department.  He did not say to me, “This is how you will practise.”  Instead he asked me, “What do you need?”  I said, “We need to double the medical staffing of the department.”

At the time, I didn’t think my answer went down very well.  And yet, within a few years, it happened.  Nowadays I tell UK doctors about the medical staffing of NZ emergency departments and they just don’t believe me. 

In the UK, the line of command is top down.  Yet the idea that a Minister of Health should tell clinicians how to practise strikes me as being completely absurd. Mr Hancock tells the Royal College of General Practitioners to stay on Zoom for perpetuity.  I cannot understand why the RCGP, a very large and powerful college, don’t just tell the Health Secretary to take a running jump. 

Scott Morrison, the Australian PM, arrived in Queenstown NZ yesterday to have talks with NZ PM Jacinda Ardern.  Australia and New Zealand opened a quarantine-free travel bubble last month.  (Currently there is a viral outbreak in Melbourne so NZ has suspended the arrangement with Victoria.)  But in Queenstown, under the wintry slopes of the Remarkables, there is no need for face coverings or social distancing.  Mr Morrison and Ms Ardern even greeted one another with a Maori hongi.                                                   

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