Richard North, 30/05/2021  

Addressing the events of the past week, we have been assailed with a wide variety of issues, some important and some not. In a perfect world, one would have thought, the news media would concentrate on important events, but that begs the question of what is important.

The trouble here is that there is not and cannot be any single definition of what is important, as different groups have their own interests and values. The biggest split, though, tends to be between providers and consumers. Very often, I would hazard – especially in politics - there are major differences between journalists and the consumers of their products think is important.

It may be even more subtle than that, as the great British public might actually agree that a particular issue is important, but actually not be prepared to read about it (or tune into the broadcast news). The public may even be confused by what they are being told, or find it overly complicated, and switch off mentally even while acknowledging that what they are being told is important.

In a general media outlets (broadcast or print), providers can compensate for this by leavening the "important but uninteresting" with the trivia of slebs and other matters. Thereby, journalists keep people entertained, thus allowing them to focus on that which interests them. It is a sort of Faustian bargain: where the tat is provided in exchange for a licence to pursue more worthy issues.

There is a sense that this is happening at the moment with the Cummings evidence last Wednesday to the joint Science and Technology and Health and Social Care Committees. There are plenty of polls to tells us that, in the main, people don't trust Cummings – even less than they do Johnson – and this reflects in the diminishing interest in his testimony.

On the other hand, presented with seven hours (or thereabouts) of raw testimony which opens up a portal into the very heart of this government and both the political and media classes are rooted in fascination. Days later, they are still chewing over the details, long after most ordinary people have lost interest and moved on to fresh pastures.

More often than not, when the media get locked into one of their periodic obsessions, the public is right to move on but, just for once, I believe the media are right to stay with the issues raised by Cummings, even if general interest is waning.

But it is not just the media who are fascinated by what Cummings had on offer. We learn from a lengthy piece in the Observer that it had originally been intended that Cummings's appearance should last three to four hours in total.

However, the two session chairmen, Greg Clark and Jeremy Hunt, quickly came to the realisation that time limits on Cummings were no longer realistic, or in anyone's interest. They thus agreed between them to let the Cummings show roll … and roll.

"To lift the lid on the inadequacies of a government he served, in the face of a crisis like Covid, in the way he did – so calmly – was unlike anything I have ever witnessed", said one committee member. And that is why it was, and still is, important.

The Observer piece – rightly in my view – also suggests that, of all the excoriating claims made by Cummings, it was the one about Hancock claiming hospital patients would be tested before they were returned to care homes that could be most serious.

Here, there is no doubt that the leader of the opposition, Keir Starmer, sees in this a political opportunity. In an authored piece - also in the Observer, he writes:
That national spirit deserved strong national leadership. Leadership which protected our most vulnerable when they needed it. That leadership was lacking. Nearly a quarter of those who tragically died were the most vulnerable of all – those in our care homes.

This was the generation that rebuilt our country after the second world war. You don’t have to believe Dominic Cummings to see that what happened was a betrayal. Care homes and care workers were left exposed and unsupported.
He goes on to say that leaders should be willing to tell unpopular truths, but Johnson dithered and delayed because he didn't want to do so. The only tough decision Johnson took last year, Starmer says, "was to throw a protective ring around Dominic Cummings, not our care homes".

Thus, we're very far from seeing the last on the care homes issue, especially as in two weeks' time, Matt Hancock will be giving evidence to the Greg Clark and Jeremy Hunt show.

Illustrating how much there is to rehearse, the Observer offers a third piece, this one headlined: "Patients were sent back to care homes without Covid test despite bosses’ plea". The sub-heading identifies the narrative, telling us: "Pressure piles up on Matt Hancock after managers say they felt 'abandoned' by health ministry in first wave".

There is nothing dramatically new here, but we do learn that, as the Covid crisis began to unfold in early March 2020, care providers had an emergency meeting with department of health officials.

There, we are told, they urged the government not to force them to accept untested residents. However, weeks later, official advice remained that tests were not mandatory and thousands of residents are thought to have returned to their homes without a negative Covid result.

Adding to the weight of anecdotal evidence from other sources, we have the Observer retailing how some homes came under "huge pressure" to take back residents, including being told that a transfer had been sanctioned by a senior manager when no agreement had been reached.

The owners of a nursing home in the Midlands told the Observer that they had felt "completely abandoned" by their local health service. "The first thing we saw was district nursing teams withdraw – they wanted us to take on dressings and injections. Then GPs stopped coming, and when we got messages it was only about end-of-life care".

Other social care officials spoke privately last week of a small number of situations last year where paramedics had refused to go inside a care home to treat residents.

Another point of interest is the concerns about "misleading figures" being offered by Public Health England (PHE) about the potential number of deaths that resulted from the return from hospital of untested residents. It has released a report written last October that claimed only 1.6 percent of outbreaks in care homes – 806 cases between January and October last year – had come from inpatients who had been discharged from hospital.

Vic Rayner, the chief executive of the National Care Forum, avers that the conclusions of the PHE report seem "highly unlikely". She said the report only considered those who had tested positive, and it barely acknowledged that the vast majority of the 25,000 people who were rushed out of hospital in March 2020 were not tested for Covid at all. The report – only released the day after Cummings gave evidence – made no attempt to calculate how many of the untested patients may have spread Covid in care homes.

Unravelling all this is going to take a huge effort, and I'm not sure that the joint select committee will be up to the task, especially when it comes to identifying when and why crucial decisions were made – and by whom.

In this blogpost, I've already identified three crucial documents which were part of the decision tree which led to hospital patients being discharged to care homes, but there were at least two more.

The first was published in 2009, headed: Pandemic flu - Managing Demand and Capacity in Health Care Organisations. (Surge )". The second, from April 2012, is headed: "Health and Social Care Influenza Pandemic Preparedness and Response".

I will be exploring these documents further, in due course, but I will leave you with the concept, introduced in the first of the two documents, of "reverse triage". The "underlying principle, it says:
… is that the potential medical benefits to incoming patients should ideally be greater than the potential risks of not receiving care for those discharged. A pandemic may necessitate such an approach to patient care in the health and social care arena. With such an approach, there has to be a level of risk tolerance of a consequential medical event as a result of discharge.
This is a practical application of the doctrine of the "greater good", and points to the likelihood that the discharge decisions were made long before Hancock got involved – even to the extent that he may not have known initially what was being done in his name.

Starmer says that leaders should be willing to tell unpopular truths, and maybe "reverse triage" is one of those – although how it was managed is another question. Like it or not, this issue is going to run and run.

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