Timing seems odd, but we need to start the conversation about the second UK NHS restart. Why do this when we are still up to our necks in the current wave? 1/n
Firstly, at some point this will either improve for the NHS or become a cyclical new normal for most of the year. In either scenario we still need to figure out the reopening of services 2/n
This was hard enough first time. Many staff were shell-shocked with no time to recover before being asked to go flat out again to clear backlogs. This meant going into wave 2 with no rest. Wave 2 has become wave 3 and the signs of staff burnout are hard to ignore 3/n
There needs to be a clear and realistic plan for the next time that factors in the current and ongoing human costs to our HCWs. There needs to be a once in a lifetime financial commitment to backing us in this mammoth task 4/n
Close the door on the last 5-10 years worth of perpetual service squeeze and constant focussing on the bottom line that has dominated every decision 5/n
Back us in innovating to help deal with these challenges. Empower and invest in the clinical leaders to make changes. This will not deal with everything. Much of our challenge right now is simple lack of staff on the ground but the... 6/n
...pandemic has already opened a door for change. With the constant threat of cuts removed, a genuine commitment to improving infrastructure for, amongst other things decentralised and quality digital health care and... 7/n
... a clear signal that we are valued and trusted to lead our services (and not just some Heath Robinson public led hand-clapping) then we might just bridge some of the coming gap and prevent the impending exodus of people leaving for other jobs/countries. 8/n
I don’t think we have a lot of time to get this right, but there is also a unique opportunity to get something positive from all of this. 9/n
Most of my colleagues are motivated by visions of better ways to deliver care but rarely have the investment to realise these visions. Now would be a good time to have a punt on letting us try.

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More from @mark_toshner

24 Jan
Thought a longer thread on the Pfizer delayed dose in UK might be useful. 1/n
Firstly important to keep local UK context clear. Pfizer will end up a minority vaccine in UK so this will not have much of a long-term effect on population coverage. However because of the way we are prioritising, it will disproportionately land in 2 groups. 2/n Image
Those are HCWs and over 80s. HCWs are as a population low risk for serious complications. They are at the front of the queue for the same reason you put your O2 mask on yourself first before your child on an airplane. Right now we are generally pretty critical. 3/n
Read 13 tweets
24 Jan
Vaccine news coming out of Israel remains positive. google.co.uk/amp/s/amp.ft.c…

Few comments. 1/n
The statements on antibodies are reassuring and in line with the infection profile 2/n
However most of this data pertains to younger HCWs. I still think for HCWs the UK calculated gamble to delay second jab is reasonable and one I am personally comfortable with having had only one. I haven’t seen any older population data... 3/n
Read 5 tweets
30 Dec 20
I've been tweeting about vaccines for a while now. Next 6 months are crucial in misinformation war so here are a few things I have learned 1/n
1) Vaccine hesitancy is widespread, and a lot of it is soft. Many folk just need simple concerns addressed 2/n
2) People have a complex set of concerns. You need to understand them. Some can be addressed, some not. Keep an eye on what they are as they change 3/n
Read 10 tweets
20 Nov 20
Next vaccine thingy to address. Getting asked mostly about long term vaccine effects. Important to be straight/honest. Nobody knows yet. Best way to understand the future is to look at past so... 1/n
... if you look at every vaccine ever developed, you see a clear pattern. Side effects are overwhelmingly short term. It is built into how vaccines work. 1-2 doses promote short term immune response that primes us for later. 2/n
You probably don't even think twice about this when you get your flu jab. Let's be honest, who has read the evidence for flu jabs (I haven't). It is such a non-event I roll up and get one, feel a bit rough for 2 days, moan to my wife then get on with life. 3/n
Read 8 tweets
17 Nov 20
More on vaccines. I'm going to get boring and geeky on this (no apologies) on the 10 year thing. Vaccines "normally take 10 years". This is being use as a reason to be fearful (ie rushed job). I'm a clinical trials doc. I can tell you most of that time is spent doing...1/n
.... nothing. It's spent submitting funding requests, then resubmitting them, then waiting, then submitting them somewhere else, then getting the money but the company changes it's mind or focus, then renegotiating then submitting ethics, then waiting for regulators...2/n
...then having problems with recruitment and having to open other sites, then dealing with more regulatory issues, then finally when you eventually get to the end of all of this you might have a therapy...3/n
Read 7 tweets
13 Nov 20
On vaccine safety. 13 million vaccinated people studied. Mortality rates much lower than background population. Not a comment on causation (though seems bloody obvious), only safety
sciencedirect.com/science/articl…
With this in mind I present 5 things a vaccine is safer than 1/n
Based on above and NO REPORTED DEATHS in the 1000s of patients so far enrolled in vaccine studies, here are 5 things more dangerous than a COVID vaccine
Number 1 (close to my heart after Scotland heroics)

Watch football penalties
ncbi.nlm.nih.gov/pmc/articles/P…
Number 2 (HSE 2020)
Climbing up something at work Image
Read 7 tweets

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