A hugely important moment in the consultant pay campaign. To get from "no more talks on pay" to any offer worth putting to members is massive progress, thanks to the strike action @TheBMA members had to take to force the Government to the table.

What do I think of the offer...? I'm not going to offer my own opinion (I know, you're all disappointed), at least not yet. The BMA isn't formally endorsing the offer, and it's for everyone to decide whether it works for them individually.

Clearly it's not perfect; it's as far as our negotiators could push it.

If you’re a consultant or work with consultants, it’s important to pass on this warning: the next 48 hours of media coverage will be relentlessly negative about doctors. They’ll harp on about private work, pensions, inflation and all kinds of nonsense.
Forewarned is forewarned. The negativity is designed to sap the will of striking workers. They’ll make it seem like the whole country is lined up against you and that you’ve made a bad decision to strike.

Don’t believe them; neither is true. You can see it for what it is: Government anti-strike rhetoric.

That doctor telling Sajid Javid that he doesn't want the vaccine because he already has antibodies from having had covid before overlooks the point that he *survived* that infection.

There's no such thing as "natural immunity" to covid, only "surviving the infection". Yes he has antibodies that *might* be of some use against omicron, although plenty of people have had delta and then immediately caught omicron too (I don't know about hospitalisation rates for them, though). But he survived despite being unvaccinated... which is nice for him.

Ppl cross at those saying we should have vaccinated more people worldwide insist “SA has plenty of vaccine. *Hesitancy* is the problem, not supply!”

That misses the point: the call is for the outcome (vaccinated people worldwide) not the means (vaccine supply, education, staff) We certainly shouldn’t punish SA for having helpfully spotted and transparently announced omicron’s development.

Omicron may well not even have arisen in SA, sure, but it doesn’t matter where the person was in whom the mutation first happened - the maths remains the same.

IMAGINE: there’s been a war. Pilots in the UK have been flying stressful emergency evacuations in huge numbers, in aircraft they’re unfamiliar with, sometimes without the kit they’re used to. UK was caught out (despite warnings); thousands have died. We nearly ran out of planes. The war has abated a bit, but pilots haven’t had a proper rest in months.

There’s a huge backlog of people whose non-essential flights were postponed to free up planes for evacuations. The air service is working its way through the list by priority.

Now it’s your turn to fly.

Very disappointing to see NHS England insisting GPs return to face-to-face when it’s been available for people who need it throughout the pandemic. On top of trying to deliver a vital vaccine programme, now GPs are being vilified for no reason, assailed by unreasonable demands. GP friends of mine are reporting aggressive demands from patients, staff deeply upset by the misleading media reporting and the vile comments underneath, and a sense of anger and exhaustion from a workforce that continues to give its all, as it has done throughout. Most unfair.

We nearly got to this point in the UK, just so you know. We stopped using propofol infusions in theatres bc it was all being used up in ICU. We also nearly ran out of muscle relaxants. We racked our brains to think of alternatives. Restraints weren’t on the agenda here, AFAIK.

https://twitter.com/bnodesk/status/1382790485329252354

I would suggest that if you get to the point where you can’t sedate people for intubation then your healthcare system has failed - broken down entirely - and you need to move formally to a triage situation. Unthinkable and yet here they find themselves.

Here's another (long) thread about normalcy bias - this time in relation to healthcare systems breaking down.

I will start by saying the worst case scenario in this thread hasn't happened here yet, but there is a distinct possibility it might happen in some places for a time. We have heard a lot of talk about "the NHS under unprecedent pressure", or "hospitals under huge strain". The NHS is a flexible system, and it can deform under pressure without breaking (rupture). But eventually even flexible things will break after reaching their elastic limit.

The difficult thing about the breakdown of society as we've grown used to it is that it's usually not an abrupt collapse. The Decline and Fall of the Romans took a few hundred years from the end of the Republic to Romulus Augustus. It's also not clear-cut that it *has* occurred, except in retrospect when an inflection point might (or might not) become clearer.

When you're living through it, every step on the path to neo-fascism seems *unwelcome*, sure, but not necessarily decisively catastrophic in itself.

I think it's probably not right to claim the NHS "coped with the first wave of covid".
Yes, we avoided a triage situation of choosing between covid patients for the last ICU bed.
But that was bought at the cost of stopping everything else. That's not coping, it's redistributing. We shifted resources - staff, space, kit - from most other parts of the service to meet the anticipated demand from covid. We'd seen Italy's health service horribly overwhelmed by their first wave, so it was an appropriate response. But it wasn't new capacity that we'd created.

I've now had 3 people tell me in the last 24 hours that they have broken lockdown, citing Dominic Cummings as justification.

His resignation is genuinely required as an urgent and powerful public health intervention; people are flouting the rules bc he did without consequence. As I've said in another tweet, Cummings isn't solely responsible for lockdown adherence weakening. But while he so publicly goes unpunished for breaching the rules, it undermines the sense that *other people are adhering* which is so critical to a collective behaviour holding.

Today we moved the last few covid patients out of our surge ICU (RICU - formerly Recovery) up to the adult ICU at my hospital.

We stood this unit up in a couple of days, staffing it 24/7, not knowing how long it would be for. It was a whole-team effort; everyone gave their all. Many patients came through our doors. Not all left alive, sadly, but every one of them had dedicated nurses and doctors caring for them, ICU staff backed up by HCWs redeployed from around the Trust. It was a pleasure working with them; seeing pts get better was a shared delight.

We face a social threat as well as a medical one.

In times of economic hardship, people turn to political extremes (and we're not exactly in a place of national consensus right now anyway).

A deep, deep recession is ahead as the ground falls away ahead of our feet. (Thread) Governments around the world are acquiring new, emergency powers to address the pandemic. Sadly, governments rarely give up all these powers when the emergency ends, without a change in government.

People accept and welcome the powers at the moment because it helps fight covid.

Do me a favour: if you know someone who has gone out socialising tonight, text them and tell them that I would willingly take them to intensive care in 8 days' time but there might not be a ventilator left by then, so it's up to them, really.

STAY INDOORS. THIS IS NOT A DRILL. There's a fine line between sensible anxiety about what could become a dire situation if we don't #FlattenTheCurve, and unproductive panic.
Keep calm, follow official advice, find your local support group and volunteer to help others if you can. 😷🥰
Also:
nhs.uk/conditions/cor…

Government admits: medicine supplies will be delayed by No Deal Brexit - guidance slipped out quietly today advises providers to plan for lead times to more than double.

People's lives are at risk from Brexit.

#DyingForBrexit

gov.uk/guidance/how-h… Over 5% of all imports to the UK are medicines.
80-90% of all generic medicines are imported from the EU.
3/4 of NHS medicines are generics.

Extra procedures and delays at the border will have a huge impact on the NHS's ability to get medicines to those who need them.

I've tweeted about this before but the protests this week have led me to think that there is hope that the normalcy bias that paralyses our nation can be overcome.

medium.com/@thomasdolphin…

How is normalcy bias stopping us from acting? (short thread - or read the article!) Normalcy bias is a cognitive flaw we all have that sometimes prevents us responding appropriately to grave threats. Because things have always worked out okay before when the alarms have gone off, we discount the risks and genuinely believe that things will be fine this time too.

Cognitive dissonance can explain some of the difficulty Remainers have convincing Leavers of how damaging Brexit will be.

Humans find it hard to hold conflicting ideas in their heads. It creates dissonance or tension which needs to be resolved one way or another.
1/12 One strongly-held and deeply-seated concept people have is their self image, which usually has positive things in it, including something like “I am sensible, worldly-wise and not easily fooled”.

Self-image comes about over years and is deeply-rooted in our minds.
2/x