Dear Prime Minister,

I will be brief.

Ideology has no place in a national crisis. You must do the first part of your job: protect the people. The second, promoting growth can only be done after you have been successful in the first - living being a pre-requisite for success.
I fear I am not getting through to you. Another way then. When the dust settles, and the true endemic level of SARS-CoV-2 is known, there will be a tally. There will be a count - with all the data, across all the domains that the many observers have collected.
The count will not be in your favour. In fact, when historians put pen to paper, the Johnson-era - on your current trajectory - will be remembered as a cautionary tale, a bookmark in history to teach those that come after you a simple fact: decisions are rarely binary.
Your example will help others learn the importance of robust infrastructure and solid foundations from which to grow a healthy, secure economy. That, moving quickly to protect the people (you may know them as the workers) during a crisis protects national interests.
As we move to your fourth attempt, with society simmering, security diminishing, and your people - the people you are supposed to protect - facing the terrifying prospect of falling ill on a depleted battle field, perhaps now is the time to reflect and take informed council.
Your approach so far has neither saved lives nor saved the economy. No, Covid is nothing like flu. Tripling the death rate from pneumonia is noticed. Failing to provide any additional basic healthcare capacity for the additional patients to receive treatment has been noticed.
A word of advice then. The double whammy is not the one you think it will be. It will be defeat from Covid and defeat from the many, many non-Covid health outcomes that continue to diminish on your watch. Maybe eventually the free market will take the reigns, but for now...
..this period has taught us: when global catastrophes are in play, it is the quality of the State that matters.

Sincerely,

Daniel Goyal

@BorisJohnson
Overwhelmed by the support. Thank-you all.

I nearly didn't post it 😷

We may not be able to rely on Political Parties but perhaps we can still rely on each other... Graph showing level of trust in professions.  Doctors are to

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More from @danielgoyal

22 Oct
The truth about the GP crisis...from a non-GP doctor.

I share this with you for 3 reasons:

1. To highlight the source (and fault) of the current GP crisis.

2. Because the primary care crisis is at a critical point and can be salvaged.

3. Public support matters.
We go back to March 2020, when all the health service staff were preparing for the arrival of this new, unknown pathogen. We were all nervous.

Those who expected to be right in the thick of it were:

Primary care - GPs, DN's, receptionists, etc
A&E (+ paramedics)
Medicine
ICU
For those who don't know, the typical pathway begins with the GP or Practice Nurse..

they assess, then either test and send home with advice, or send to A&E for further assessment...

if deemed 'unwell', they are admitted to medics.

That is what we were preparing for.
Read 20 tweets
20 Oct
Covid-19 and Herd Immunity

What is the clinical harm associated with pursuing a herd immunity policy?

1/15

#GovernmentCovidCatastrophe
@IndependentSage @DMinghella @doctor_oxford @ShaunLintern @dgurdasani1 @trishgreenhalgh @Kit_Yates_Maths @chrischirp
@TheBMA #TeamNHS
Putting aside whether it will work or whether a Health Immunity Strategy (HIS) is ethically right...

What will be the CLINICAL harm to the UK public of allowing SARS-CoV-2 to spread without any mitigation strategies?
We know access to healthcare during a pandemic saves lives and prevents disability.

We know the greatest barrier to a "catastrophic loss of life" with HIS is healthcare availability @wtgowers @ChrisCEOHopson
Read 15 tweets
19 Oct
#COVID19 and '111'

Serious questions about the '111' Triage Service.

Is it fit for purpose?

@NHSDigital @DrGregorSmith @CMO_England @doclourda @CMOWales @FatmaMansab

dx.doi.org/10.1136/bmjhci…
Our study published today in the BMJ HCI examined the NHS '111' online triage tool.

Results include:

It could not reliably differentiate between mild and severe Covid-19.

It missed severe cases, advising such cases to say at home.
The study used 52 cases simulating various presentations of Covid-19 from seven national online triage tools.

Reliability was poorest for the '111' version.
Read 19 tweets
18 Oct
Clinical Response to COVID-19

How are other countries providing care to COVID-19 patients?

Here we compare UK versus Singapore.

[Evidence at end of thread]

1/n
SINGAPORE

TRIAGE:

Any cold/flu symptoms are triaged as ?#COVID19

ALL suspected or confirmed Covid cases are clinically triaged at public health clinics (run by primary care).

All cases have vitals taken, are swabbed and are clinically assessed.
FOLLOW-UP:

ALL cases are followed-up 3-5 days later, with an open-return policy

If confirmed positive (clinically or PCR) or develops signs of LRTI..

..patients transferred by dedicated ambulance to secondary care assessment.

Mean time to admission - 2.6 days (over 1yr)
Read 16 tweets
17 Oct
It's time to admit this is a national emergency and act accordingly.

The #NHS has never sustained these demands. And they are only increasing.

The UK government has no insight into the problem and it seems they have neither the skills nor the fortitude for such crises.

1/n
We have:

1. NHS pre-winter bed capacity beyond 95% - #NHS
2. The highest demand for primary care services ever recorded
3. An NHS staffing crisis
4. An unmitigated pandemic - #COVID19
5. An absent government
It is dangerous to run a hospital above 85% capacity. When space is tight in a hospital, risk increases.

Risk occurs as we must try and avoid admissions and expedite discharges. @NHSProviders
Read 22 tweets
15 Oct
The British public feel abandoned by their GP (and the NHS generally).

They feel GPs were hiding from the pandemic and afraid of getting #COVID19

The truth is so much more concerning…

@RCGP
@trishgreenhalgh @MartinRCGP @martinmckee @DrSimonHodes @drphilhammond
1. This government, under PM #Johnson And against the will of #TeamGP, bypassed GPs during this pandemic.
As shown in the above thread, There was a very clear objection by many GPs and GP leadership to being side-lined by the government’s pandemic strategy ….back in April 2020!!!

THIS IS OUTRAGEOUS!!!

And the public are completely unaware of this.
Read 8 tweets

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