Thread by @pmdfoster

NEW: The inside story of the Ventilator Challenge - the muddled thinking, the wasted time the political egoism. It's a mad tale. Stay with me. Me with my superb @ft colleague @Michael_Pooler 1/Thread

ft.com/content/5f393d…

@FT @Michael_Pooler So it starts around March 13 as the #coronavirus storm clouds are gathering in Italy. Panic is on in UK to DO SOMETHING and, worse, UK doesn't have much advanced manufacturing capacity. Government is under pressure. What to do? /2

@FT @Michael_Pooler Well, start on March 14 by summoning the 'Blitz spirit' which @MattHancock does on March 14 in @telegraph article here, urging UK manufacturers to pivot production lines to make ventilators. "We cannot make too many." And lots of wartime blah. /3

telegraph.co.uk/politics/2020/…

@FT @Michael_Pooler @MattHancock @Telegraph But the question soon arises - WHAT should those manufacturers build? Do we build from scratch? 'Reinvent the wheel' so to speak? Or tool up/expand what existing capacity we have? Or seek to make stuff under licence? This is the BIG question..../4

@FT @Michael_Pooler @MattHancock @Telegraph And the answer comes on March 16 when @BorisJohnson does a conference call with all of the top industrial bosses. They want something simple, non-ICU that can be mass produced - as an insider on the call tells us:/5

@FT @Michael_Pooler @MattHancock @Telegraph @BorisJohnson In fact, it is SO simple that the draft 'indicative' specification circulating at the time carried a YouTube video tutorial for a Manley Blease ventilator designed in 1961 that, as the narrator says, has been 'consigned to the history books' /6

@FT @Michael_Pooler @MattHancock @Telegraph @BorisJohnson Now hindsight is a beautiful thing. The government says it was 'looking at all options' - a simple ventilator is better than NO ventilator.

But to be clear even at the time people who understood both ventilators AND manufacturing were raising serious misgivings. /7

Look at this @BBCNews report from March 16 - the day of the @BorisJohnson call.

MakeUK boss @Makeuk_Sphipson told Today we'd be better making existing stuff under license.

@PenlonGlobal head of products says it is "unrealistic" to make from scratch/8

bbc.co.uk/news/business-…

@BBCNews @BorisJohnson @MakeUK_SPhipson @PenlonGlobal But still, that's what the govt chooses to do - starting what one insider dismissively described to me as a 'hackathon' to reinvent the complex wheel that is a medical ventilator.

The boss of GTech, a Worcester garden appliance thought it was 'hoax'. /9

worcesternews.co.uk/news/18322604.…

@BBCNews @BorisJohnson @MakeUK_SPhipson @PenlonGlobal But when the regulator publishes the first formal 'spec' for the new ventilators it is need super-simple.

The 'intended purpose' is that these vents should work for a 'few hours' and 'in extremis' 24 /10

@BBCNews @BorisJohnson @MakeUK_SPhipson @PenlonGlobal The basic ventilator spec also does not contain really important features including “spontaneous breathing modes” — the ability of ventilators to synchronise with a patient’s breathing as a key part of “weaning” patients off respiratory support. /11

@BBCNews @BorisJohnson @MakeUK_SPhipson @PenlonGlobal Now. The government insists that this was all done with the advice of both top doctors AND the regulators. That's what it says. /12

gov.uk/government/pub…

@BBCNews @BorisJohnson @MakeUK_SPhipson @PenlonGlobal But is that true? When I showed that spec to @AlisonPittard last week, she was amazed. Yes docs were prepared to have less-than Rolls-Royce features, they could live with a Ford, not a Ferrari. But this is a spec, basically, for a Trabant /13

https://twitter.com/pmdfoster/status/1250316319481671681

@BBCNews @BorisJohnson @MakeUK_SPhipson @PenlonGlobal @AlisonPittard What about the Regulators - the MHRA - they what did they think? As we report, insiders, say that quite quickly there was push-back about the utility of these basic vents, the damage they would cause, and their utility in weaning patients back to health. /14

@BBCNews @BorisJohnson @MakeUK_SPhipson @PenlonGlobal @AlisonPittard Initially when those concerns were pushed up the chain, the reply came back "that's what the customer wants".

Which begs a question. WHO was the customer?

Not the docs. Not the regulator. Not the patients.

The only answer that fits, is the Government. The politicians. EESH/15

It takes time for the penny to drop in Whitehall and the Cabinet Office - but by April 10, check out the 'amended' spec that says “the greater proportion of devices” for treating coronavirus would need to be capable of supporting “spontaneous breathing modes”/16

The result is that the Bluesky consortium - which HAD BUILT to spec is canned on April 11. And others like the 'Oxvent' scheme (another low-spec effort) is paused. Insiders tell us that quite possibly none of these 'hackathon' designs will get approval /17

Why does this matter? The government did change tack in the face of medical and scientific pressure and (mercifully) it was spared its blushes because ventilator capacity held up, clinicians used more (non-invasive) CPAP and (probably) more deaths happened in community. /18

So no harm done? No. Not really.

What this speaks to is the deeply worrying tendency of this crop of politicians to think they know best.

The 'cut-the-crap' 'how-hard-can-it-be?' attitudes that leads to headless decision making. It's embarrassing. /19

Over the last week I've had SO many conversations with docs and experts that remind of the conversations I had with logisticians, port operators, customs clearers over #Brexit.

Expert people TEARING their hair out at the willful numbskullery of the people at the top. /20

As a side note, this kind of treatment PISSSES PEOPLE OFF.

My inbox is full of people who daren't speak on record but are SEETHING at the way they were treated.

People who worked 20-hour days for weeks; gave freely of their time, energy and spirit for nothing. /21

The government may look to try and find an outlet for these ventilators in other places - but you have to ask, if they're not fit for UK patients (and we'll see if any can get clearance) why would they work for poorer countries? I'll be watching. /22

Because guess, a device that keeps you alive, that breathes for you IS flipping complicated. How hard can it be? Damn hard.

It's parts mustn't catch fire in a high-oxygen environment.

It's software must anticipate a patients breathing. If it freezes, you may die. /23

This was OBVIOUS AT THE OUTSET.

The government said 'the clinical understanding of the disease changed' but that is a RED HERRING.

It did, but the science was NEVER in a place where it wanted 'bag-in-a-box' ventilators. /24

What worries me is if this 'how hard can it be?' principle is applied to testing, to PPE procurement etc.

The government needs to show some HUMILITY. It needs to LISTEN TO PEOPLE WHO KNOW STUFF. I think this is a clear example of where it did not. ENDS

Good weekend all.