UKC

During the debate on excess deaths something interesting cropped up that I hadn't  seen before and I thought worthy of further discussion.

I don't agree with the spin provided by the unheard journalists in the link below but the Danish Prof was clear about assumptions etc in the embedded Youtube interview. She said:

* It is well know that vaccines can impact all-cause mortality beyond the effects of the virus being countered. Eg measles vaccines save many lives directly from the measles virus but also reduce all cause mortality and morbidity.

*her recent work on covid vaccines show a reduction  in all-cause mortality for adenovirus vaccines but no significant change for mRNA vaccines.

https://unherd.com/thepost/study-into-mrna/

In reply to Offwidth:

What happened to the other thread, did it get nasty or just nuked for sockpuppet campaigning?

jk

In reply to Offwidth:

I'm certainly not qualified to understand the difference between vaccine types, and I've not looked at how the two results compared to each other in any detail, save to note that it said it was a small sample.

But doesn't this sort of thing live and die by what the background COVID level is at the time of the study?

- if there was no COVID, given non zero side effects the vaccines would presumably increase mortality.

- At a low level, they make no discernable difference, if this work is correct.

- At a high level, presumably this would be a specialised but not very newsworthy study as to which vaccine did best?

I guess I'm not really sure what conclusion can helpfully be drawn in the zero or low environments, given the whole point was to provide protection in the high one.

In reply to AJM:

Quite. 

> I guess I'm not really sure what conclusion can helpfully be drawn in the zero or low environments, given the whole point was to provide protection in the high one.

Quite.

I see a big drift in the message from the primary research to the popular media message.

In reply to jkarran:

Nuked from orbit on general principles I think.  Shame, as it was a large group of posters pointing out the cherry picking of a moment in time and the disregarding of typical variance.  Happy to see posters using critical thinking with the data.

In reply to AJM:

As far as I'm aware it still needs peer review but the adenovirus decrease in all cause mortality and the specific cardiovascular subset were both said to be statistically significant. The earlier work on other vaccines (inc measles) was peer reviewed.

It's completely unrelated to my excess deaths points: where I think we have a low background (as a significant excess proportion of the most vulnerable/elderly died in the pandemic) masking a problem almost certainly related to NHS and Care pressures. In that situation 30% increase in deaths at home is a big factor.

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriage...

In reply to wintertree:

The unherd spin is clearly problematic

https://www.politifact.com/factchecks/2022/may/06/youtube-videos/fact-check...

I'm interested in the all cause mortality results as although it clearly needs more research the adenovirus vaccines might have advantages beyond protection against severe covid infection/death. Plus AZ is cheaper and has been rather unfairly maligned.

In reply to AJM:

I think it is a study of vaccine trial data.

IIRC the Pfizer trial had about 20,000 people equally split between intervention and control groups.  I have seen slides but cannot link to the summary trial data.

During the trial period there were ~25% more deaths in the intervention group than the control group.  The numbers were small like 11 & 8, this disparity was not regarded as significant. Moreover, the trial was not designed to measure mortality effects.

In reply to Offwidth:

While ambulance service overstretch will certainly have played a part in the 30% increase in deaths at home, a bigger part is almost certainly down to the large increase in DNACPRs being issued during the pandemic. A very typical scenario, without a DNACPR in place, is medics working a futile resus right up until delivery to A&E only to have it called within minutes of arrival. That’s when time of death is noted and on paper at least, it’s not a death at home.

In reply to Stichtplate:

Good point. There are any number of health issues that could increase deaths at home in our overstretched health services but that is sure to be one of the bigger causes. I think the increasing risks related to declining quality and provision of care at home on health is often ignored: well over a third of a million recieving care assistance at home and hundreds of thousands refused. Staffing issues..... due to: brexit, the government requirement on vaccination and covid illness and isolating, increased stress in a much busier job.... all take their toll.

In reply to Offwidth:

There’s also been a huge culture shift in service use by the general public. The number of 999 calls to the ambulance service has doubled in just 10 years, while staffing levels have increased by just 7%. 

The longer wait times have corresponded with an equal increase in callers exaggerating symptoms in the hope of ensuring a quicker response. Net result: the genuinely life threatening presentations aren’t afforded the priority response they justly warrant.

In reply to Stichtplate:

Is that a case by case instruction from base not to attempt resuscitation? If so, what's that based on, case history from the 999 call?

jk

In reply to jkarran:

A DNACPR is a guidance document typically issued by a GP or hospital and has to be on scene with the patient to be taken into account. If there are clear cut, irreversible signs of death (rigor mortis, hypostasis, missing head etc) we don’t start resus attempts. Paramedics do have the authority to judge if resuscitation is futile (with certain exceptions) but they’d better have very good reasons to present if they end up in coroner’s court

In reply to Offwidth:

Per the point I made in the nuked-from-orbit post, if you look at where those couple of weeks of data stand compared to the 5 year volatility rather than the 5-year average it stands out less.

I think the same caution should apply with greater weight when looking at any sub splits within the headline figure, since the more you sub divide the data the noisier it gets.

You may be right, but I'd want to see what a normal level of fluctuation in the makeup of excess deaths by location looks like over the relevant time window before I took a view on how significant the numbers are.

That doesn't detract from the overall argument about NHS overstretch, before you go off on one, since I don't think the outcome on these figures is particularly necessary to draw that conclusion regardless!

In reply to AJM:

A point I seconded on the nuked thread.

As you say, with sub-division by category the data becomes very noisy and for anything short of an outright pandemic it's going to be very challenging at the time to understand either the true statistical significance of a couple of weeks' of data or the underlying causes. 

In reply to jkarran:

It's worth doing a Google news search on "DNACPR" to see some of the stories from earlier on in the pandemic; various allegations over mis-issuing and pressure-issuing them against the appropriate way of doing things.

In reply to AJM:

The private home excess data has been averaging around the high 20s percent since April (and consitently higher than excess deaths percentage elsewhere) and deaths in private homes is a pretty large fraction (about 1/5 of the weekly total) there is a need for caution  but not over-caution.

Totally agree the clear NHS overstretch is only a related issue. I think we owe a massive debt to NHS and Care staff that the figures are not a lot worse, given the pressures they face.

In reply to Stichtplate:

Thanks. It seemed odd that a collapsed person at home would have DNR documentation but I guess a lot of people you see are already very ill before the collapse or family are present. I'd assumed it was more of a thing in the hospital/hospice setting.

Jk

In reply to jkarran:

My mother (94) lived at home with carers visiting and had a DNR discussed with my sister and me. She was admitted to hospital after a fall and died 10 days later, causes included covid. Thankfully she avoided indignities like intubation etc. She knew her time was up. RIP.

In reply to Offwidth:

Coming up with a convincing counterfactual for the calculation of excess mortality *that accounts for everything that has happened to mortality rates and health in the last 2+years* is *very* challenging (eg there is almost certainly some mortality displacement ‘baked in’ to current mortality rates, but how much, who knows). So I’d treat *all* estimates of excess mortality as being pretty dubious right now. Or at least, you need to think pretty hard about what the assumptions underlying the counterfactual mean and what that means for how you should interpret the resulting excess mortality estimates. And it’s almost certainly not the way that you want to be able to interpret them.

In reply to victim of mathematics:

On top of all that, there’s also significant evidence non-covid mortality rates are increased several times for pre-vaccination covid survivors in their first year post infection.  I doubt that increased mortality risk suddenly stops, but it obviously takes more time to determine longer term mortality profiles for covid survivors.  Seem like we’re going to expect some excess mortality in covid survivors for some time to come?  

I’d like to see something like your comment added to the primary data sources so when the Daily Mail or it’s ilk runs with a warped interpretation, people could at least point to the statement.  Then again the yellow card vaccine scheme puts an “interpretation warning” on its data and that didn’t stop people.

In reply to jkarran:

A DNACPR doesn’t come into play if someone has simply collapsed, it’s for cases where someone has stopped breathing and/or their heart has stopped. For a great many of the very elderly or the very sick, this is because their life has met it’s natural conclusion.

There’s an increasing consensus that the medical profession has been over treating natural deaths to the detriment of the patient’s best interest, turning what should be a peaceful end into a highly kinetic and intrusive farce with a vanishingly small prospect of success. I’ve never heard of anyone in their 80s leaving hospital with a good outcome after arresting.

DNRs are entirely appropriate for a large proportion of the very elderly and it’s a conversation I’ve had with my own parents who I love very much.

In reply to Stichtplate:

I'm absolutely appalled at that statement!
It's 'whom', not 'who'...

In reply to FactorXXX:

Soz, I’m a bit common 🤷‍♂️

In reply to Stichtplate:

Don't worry, I only know it because of a 'Not The Nine O'clock News' sketch:
youtube.com/watch?v=tTv5ckMe_2M& 

In reply to wintertree:

Can you explain how you think that ties up with below average excess deaths earlier in this year (I think its partly because NHS pressures have unusually been building into spring)?

https://www.statista.com/statistics/1131428/excess-deaths-in-england-and-wa...

Maybe I should calm down a bit, given my hero Colin's rather po faced warning (stating the obvious) but I'm always excitable about the country largely ignoring NHS pressure, so pretty obviously am being somewhat political. This is only UKC and a bit of human emotion seems appropriate to me in the face of so much shit.

The heatwave and emergency services pressures and covid sickness absence have put NHS problems back on at least one front page tomorrow (The Metro).  

In reply to Offwidth:

As said on the previous thread and this one by several posters - small numbers, noise statistics and a highly irregular couple of years severely limit interpretation right now

As I've said on this thread ( it's going to be very challenging at the time to understand"), I don't think we're going to find much meaning in these statistics right now - it's going to take a lot of time to unpack them.  "victim of mathematics" has gone in to more detail on that, and I hope you'll recognise their professional background in these statistics (which I am lacking).

There's push and pull to the Covid related mortality; those who died directly of Covid (especially pre-vaccination) became excess deaths over the past two years, contributing a dearth of deaths now.  Those who survived Covid (especially pre-vaccination) will contribute an excess to deaths now and for some time going forwards as their lifespan is shortened post-infection.  The data isn't there on the change to the medium/long-term mortality profile from surviving Covid (especially pre-vaccination) to produce any sort of meaningful understanding yet.  

Four posters including myself responded to the OP on the deleted thread pointing to multiple ways in which the OP was cherry picking - one short moment in time vs another, not recognising a sampling/jitter effect, presenting deviation from the mean devoid of the critical context of the variance or range about the mean over the last decade pre-covid etc.  If you let yourself get drawn in to the same myopic focus, it might represent a loss of objectivity.  That being said, every time there's an uptick in excess deaths it's important for those in the system to do their best to understand it; what could just be a statistical fluctuation could also be an early warning of a bigger problem.

I'm actually amazed that the wheels have stayed on as well as they have so far this year.  The NHS was clobbered by Covid, and clobbered more than it could have been under better early management of the pandemic.  I think that like you, I am very pessimistic about what this winter is likely to bring across the spectrum, but I'm trying to resist being drawn in to jumping on to the negativity without just cause.  Just cause needs statistical significance; given the deviance you are concerned with is bounded by the pre-Covid decadal range I don't think it's there.  (Yet.... ??)

In reply to wintertree:

I still think you're being a bit silly, like Colin. I'm not claiming certainty and am only speculative on much the same things as Speiglehalter and Hunter, and my speculation at least correlates with the time trends. The pre-pandemic year plots have explainable monthly variations which compartively go up and down and vary year to year with things like flu impact. A consistent average high twenties percentage excess private home deaths since April seems to me to be important, especially given the fairly consistent gap in that period to hospital and care deaths.

Back to the start,  the claimed clear statistical significance of reduction in all cause mortality of adenovirus covid vaccines looks important.

There are also plenty of certain 'just causes' to complain about in the NHS: from Ambulance and A&E stats, through staffing issues, to the confederation saying the 40 "new" hospitals don't look possible. Ditto for Care and Public Health.

Latest:

https://www.bbc.co.uk/news/health-62141079

In reply to wintertree:

Just in the middle of checking back issues of the ONS stats. The consistent gap between excess deaths in private homes to other settings goes back to December 2021 so far.... all the way back to Nov 12th 2021 (wk45) where the differences between location categories were first mentioned.

In reply to Offwidth

Regarding your link: the press have consistently been underplaying the severity of the pressure the ambulance service is under. Resource escalation action plan (REAP) level 4 is the highest category and mirrors the Operational pressure escalation plan used by NHS hospital trusts. This level of pressure was envisaged as a kind of Black Swan event triggered by a major incident (think, London bombing). Here's the definition:

"Pressure in the local health and social care system continues to escalate leaving organisations unable to deliver comprehensive care. There is increased potential for patient care and safety to be compromised. Decisive action must be taken by the local A&E Delivery Board to recover capacity and ensure patient safety. All available local escalation actions taken, external extensive support and intervention required. SE Regional Teams in NHS E and NHS I will be aware of rising system pressure, providing additional support as deemed appropriate and agreed locally, and will be actively involved in conversations with the system. Where multiple systems in different parts of the country are declaring OPEL Four for sustained periods of time and there is an impact across local and regional boundaries, national action may be considered."

Most of the UK's ambulance services have been at this level for the majority of the last 2 years. I can't remember when we were last at level 1 or 2 (normal pressure). It should be a national scandal but nobody in government seems to give a shit.

In reply to Stichtplate:

Exactly why I regularly post on the subject: to counter governmental gaslighting.

Back on the other subject, I'm glad for the discussion here or I never would have spotted the ONS location difference is consistent since they started publishing the detail last November,  nor heard your explanation of a reason that would be contributing to it. My respect for your work is enormous but it's great you can help us out on these forums as well.

In reply to Offwidth:

"Silly" is an odd choice of words for people raising a number of issues that make the data harder than normal to understand right now.  Another 4 posters I believe raised similar and overlapping issues on the now deleted thread.

Nor as far as I can tell has anyone said it may not be important, just that it's really hard to understand the data now, and that the headline excess death figure the OP on the previous thread raised - and that you noted concern on - was not statistically significant in terms of the pre-Covid range, and was bolstered by a clear sampling artefact.

Everybody agrees with you.  The last week of hot weather is surely going to have made things worse, and there's another temperature peak coming next weekend.  

In reply to wintertree:

I think "a bit silly" is apt which is why I said it. As I have said various experts have made similar points about current excess deaths as I have, and I disagreed with most of what the OP said on that thread.

I'm pretty sure the consistent  difference between excess deaths in private homes and elsewhere, since the information was provided last November, is clearly significant. Something has changed, since the pandemic, that means more die at home.

I think too much is made of the range at times because of specific time limited distortions: if there was a known factor adding to a period in a particular year, making numbers unusually high, and that's not operating now, comparing with that year maybe isn't relevant (in the same way you wouldn't want to compare with a background including periods in years containing  clear covid excess death peaks).

I'm interested in what is going on and talking about it, and like any good scientist I don’t fear a few mistakes. As in some of our previous disagreements I've learnt new things by digging more when I wasnt convinced (in this case this new consistent difference between excess deaths in private homes and the rest).

In reply to Offwidth:

To be honest I think you're quite muddled; your posts across this and the now deleted thread have covered 3 difference things:

1. The recent rise in total excess deaths. My comments to you were addressing that and in part what you'd had to say on that on the deleted thread, before you moved on to a breakdown by setting later on in this thread.  You can tell, because I said things like "headline excess death figure" and not "sub-categorised by setting".
2. The UnHerd article, which I hope we can agree has the wrong end of the stick on a few things, or possible the wrong end of the wrong stick.  Sure, it's interesting, but it's early stage research.  
3. The shift in death rates between hospitals and at home, seen through the lens of categorised excess deaths.  If you trace our correspondence back carefully, you may note that you are applying my comments to the headline figure out of context when you respond to them as if I made them to the sub-categorisation by setting.

>  As in some of our previous disagreements I've learnt new things by digging more when I wasnt convinced (in this case this new consistent difference between excess deaths in private homes and the rest).

I don't think we have a disagreement.  I think you are taking comments I made on X and applying them to Y.  I think you are doing the same with what VoM had to say.

The shift in deaths away from healthcare towards home looks more significant (in terms of long term trends) than the fluctuations on total excess deaths which look within a typical range.  It would be interesting to look at total death figures where the same change should be present.  I think "excess deaths" is probably the wrong lens for this, because it manifests as a deficit of deaths in some settings; ratio analysis is probably more apt. 

In reply to wintertree:

1. Yes  (and I thought I've been clear) it looks to me like current overall excess deaths are probably significant, partly because of the change from a below average level early in the year... just as the experts quoted in the papers did. It's possible I'm wrong, but so what, I wasn't claiming certainly? I don't automatically trust the range comparison as the highest past year plot might have clear causes for being above average.

2 Yes. I think we are on the same page.

3. Yes after looking at more of the data I was making a separate point.

In reply to Offwidth:

I wish I'd saved the previous thread. The range comparison I was looking at and pointed to on that thread was for about 9 years all before Covid so that comment doesn't apply.

It's all highly stochastic, and understanding it in the moment is going to be much harder than usual.  It's good that the powers that be are engaged with the data.  

In reply to AJM:" if there was no COVID, given non zero side effects the vaccines would presumably increase mortality." Presumably is a tricky word. Only if there is also no other benefit- which there might be. A little tickle to the immune system can be good for you.

All sorts of drugs can have have surprising off target beneficial effects (as well as side effects).

In reply to freeheel47:

Yes, fair cop. 

In reply to wintertree:

You just don't know that unless you have seen the breakdown of deaths with time. There may be a perfectly  sensible  reason to ignore a particular part of a particular annual plot as being untypical in a similar, albeit smaller, way than for a covid peak.

I'm sure AJM can reattach the previous link. 

In reply to freeheel47:

Exactly what the Danish Prof claims is statistically significant for adenovirus covid vaccines like AZ: a reduction in all cause mortality. Her previous work showed a similar effect for the measles vaccine (and  has been peer reviewed).

In reply to wintertree and Offwidth:

One observation on the range comparisons that I would make - there are two obvious things which are driving a wider variation:

1. In general, winter mortality is more variable - January and February have some of the widest bars. You can also see this in how much of the comparative mortality improvement in those graphs happens in about weeks 1-13. Varying strength of flu season is an obvious thing here. The potential for the high end of the range being an outlier is undoubtedly highest in winter 

2. Summer mortality is generally fairly tightly defined. Where the range widens, my hypothesis is that this relates to which weeks of the year the bank/school holidays fall, with their associated reporting delays (I haven't counted weeks, but it seems to roughly tie up). There are particularly wide bands around week 15, which seems tie roughly with the fluctuating Easter holiday/Easter weekend dates, another set of wider bands around week 22, which would logically fit with may half term, and another around week 35 (August bank holiday). Less relevantly you can see the same effect quite obviously around Christmas.

Given the fairly tight banding of usual summer mortality I would be a little skeptical that the high end of the range [edit: in summer as we are now] is a particular outlier year, but also the fuzz created by the reporting delay means that I think it will probably be a few weeks yet before you can reliably tell whether this is consistently even sticking at the top end of the usual band. The July and early-mid August variation is the smallest of the lot which gives the most stable basis for comparison.

In reply to Offwidth:

This one?

https://www.actuaries.org.uk/learn-and-develop/continuous-mortality-investi...

In reply to AJM:

No it was a plot with weekly deaths, weekly averages as a baseline and the range of plots in lighter blue. Edit...ignore that .....the weekly link inside that gives something pretty much the same.

I was going to post reasons other than health reasons, for jigs in the data in summer but you beat me to it: holidays, computer problems and strikes (and we do have a heatwave effect occasionally in summer).

I may have been partly confused in my impression in any case, as I visualised the excess death trend using statistica, whom I've just realised used a covid year as part of the baseline for 2022 data (increasing average baseline deaths in the first few months). The irony is quite funny. Edit... In your linked plots the shift effect on excess deaths isn't as high, but it still goes from the low end in the first months of 2022 to the high end now. 

"Data for 2022 is based on the 2016, 2017, 2018, 2019 and 2021 five-year average."

https://www.statista.com/statistics/1131428/excess-deaths-in-england-and-wa...

In reply to AJM:

That’s the one.  I don’t think it’s “a bit silly” to point out that on chart 1, the mortality for spring and summer 2022 (dark blue line) falls within the range of the years 2011-2019 (grey shading) so long as you smooth out the week-to-week extremes over a 2-week period.  (If you don’t, some weeks have stand out lows and others stand out highs - and your half term theory seems sensible).

Although a couple of periods of properly bonkers heat this year is going to push things up a bit?

I did, and I commented on them on the last thread.  See much the same above in reply to AJM’s link.  There’s obvious week-to-week variance and the trend is within the *pre-pandemic* range for spring and summer 2022.  You’ll not the emphasis on the time period of the range being pre pandemic, the pandemic deaths don’t bias things as you suggested up thread.

In reply to wintertree:

The grey band would be of consistent width if not for the common holiday glitch which clearly  must shift to the next numbered week in some years. If you visualise a cosistent thickness and smooth out current deaths, the current deaths level is for some weeks at the top end of the range. The glitch is exactly the reason I was suspicious of trusting what I remembered in the range.

In reply to Offwidth:

This is painful.

… and for others it isn’t.

So, we’ve apparently agreed that spring and summer (so far) 2022 mortality is within the range from the 8 most recent pre-pandemic years.

Can you see why I might resent being called “a bit silly” for pointing out that current mortality does *not* appear to be exceptional? Perhaps there are significant changes to the makeup of causes and/or settings, but it doesn’t look like the top level weekly numbers are significantly abnormal.  

In reply to wintertree:

Yes it is painful:

Offwidth 19.51

"The grey band would be of consistent width if not for the common holiday glitch which clearly must shift to the next numbered week in some years. If you visualise a cosistent thickness and smooth out current deaths, the current deaths level is for some weeks at the top end of the range."

From AJMs pdf:

"Ignoring the volatility caused by bank holidays, standardised mortality in recent weeks has been near the top of the 2011-2019 range"

For the third time, I used the words "a bit silly" because various experts have made similar points about current excess deaths as I have, and I disagreed with most of what the OP said on that thread.

In reply to Offwidth:

On the deleted thread you were claiming that excess deaths were high. 

I pointed out top level mortality was within the pre covid range.

You are now agreeing with me on that.

At no point have I been “a bit silly”.

Your argument has shifted (see points 1, 2 and 3 agreed in a post above).

I’m sticking to my point that total mortality is nothing exceptional.  It’s within the pre-covid range.  Can you tell me why that observation - which you have made too - is “a bit silly”? 

I assume you’re talking about the point you have segued to on the breakdown by setting.  I wish you’d stop applying my comments to top level excess mortality (point 1) to a breakdown of mortality by setting (point 3).  It’s dishonest. All I’ve said with regards point 3 is that I think it’s going to be hard to understand the data until more time has passed.  There’s just so much that has changed since covid, and so much that isn’t yet known about displaced deaths in each direction.  It hardly seems “a bit silly” to comment that it’s going to be complicated to understand.

In reply to Offwidth & Wintertree:

This was a really interesting thread until you two got stuck into each other (again).

In reply to blurty:

Sorry!  I’m obviously being a bit silly to stand my ground when it just spins us round in circles of ever increasing noise.  I’ll leave it there.

In reply to wintertree:

Top of a previous decade's range IS what I regard as high. For now, neither of us have any idea what was going on mortality wise in that previous highest range year.

No I've not segued anywhere: the experts didn't comment on deaths in private homes at all. 

Ive never applied your comments on top level excess mortality (point 1) to a breakdown of mortality by setting (point 3).

In reply to blurty:

Apologies if it causes genuine upset but every 'debate' I've ever had with wintertree on UKC I have learnt new things. I've been wrong on more occasions than not, and try to apologise when that is so. I've definitely made one mistake here by trusting a publc graph that included a covid year in a background average (AJM's plots are much better). I have  admitted been political (like the experts who speculated on the headline excess deaths).

Being able to argue respectfully with colleagues has always been important to me, as much to educate myself on what causes differences in perspective, as for the points of the argument. With wintertree it's a privilege, as he has a sharp mind, his work here during the pandemic has been outstanding and his private communications incredibly kind. I mean him no disrespect or malice.

In reply to Stichtplate:

No mention of the levels, but I thought a good indication of the severity and consequences.  Also doesn’t paint a picture of this having been as long running as you indicate.

https://www.bbc.co.uk/news/health-62166818

Do you have any sense for where the root cause of the indifference lies?

In reply to wintertree:

I'd say the biggest issue is the NHSE still largely controlling official trust press releases and telling lies on behalf of the government.

https://myemail.constantcontact.com/Press-office.html?soid=1102665899193&am...

https://myemail.constantcontact.com/See-what-she-does.html?soid=11026658991...

https://myemail.constantcontact.com/Trashing-their-careers.html?soid=110266...

In reply to wintertree:

Where to begin?

First off, ambulance service staff belong to either GMB or Unison and our concerns aren’t that important to either of them. If it was the Fire Service enduring these levels of overstretch and staff burnout the FBU would be tearing the government a new one every single day. Regarding staff burnout, I receive daily text messages pleading for people to come in on overtime for uncovered shifts and the last six months has seen roughly 10% of our sector’s paramedics jump ship to GP land.

Secondly, the common belief amongst frontline staff is that professionalism, common sense and work ethic decrease in direct proportion to the distance your desk is from the big yellow taxi. Upper ranks are stacked with people who didn’t like the frontline role and couldn’t cut it in the frontline role. Often promoted to get them out of the way. Maybe this is harsh but it really is the commonly held belief and the fact that service heads aren’t screaming for assistance would seem to bear that belief out.

Thirdly, the blame game merry go round: hospital A&Es blame GPs for the breakdown in primary care. Ambulance services blame wait times on delays at A&E. GPs blame everyone from the patients up to the health secretary.

Then there’s the overarching themes of the last 10 years: underfunding, service misuse, NHS waste.

I really worry for this Winter. A convergence of factors means this could be far, far worse for the NHS than anything we’ve seen so far.

In reply to Stichtplate:

I'd agree with everything you say but it simply doesn't explain the low level of press and public interest.

The unions struggle to get anyone to listen unless a strike is on the cards.

The ambulance bosses cannot breach the government message control, even if they wanted to, unless they want to be out of a job.

The blame 'merry go round' in some ways is fair... as when a system starts to break, all sorts of unexpected consequences crop up that are a real pita.

What you say is reminiscent to me of those I know who lived (and worked on important  jobs) in the Eastern Bloc before the fall of the Berlin Wall. The real problem there was the iron hand of the state and a press that was completely beholding to them. In my worst nightmares back then I never expected the UK to be heading so far in that direction.

In reply to Stichtplate:

Thanks for the detailed reply.  It seems crazy that we’re still seeing the kind of queues outside A&E that were around during Covid.  

Not just the NHS. I’m about at the point I’m going to start making a plan for the household.

I suppose next Tuesday is going to add a lot of stress to various systems, healthcare included, with what’s looking like a truly exceptional year, especially up north.

In reply to wintertree:

It's exactly what is to be expected when the establishment is sitting on its hands and the checks and balances that used to exist on government are so broken. Frankly I'm amazed it's not worse.

Boris killed 40,000+ citizens by ignoring expert public health advice, spaffed billions of public money to his pals for useless shit, lied thousands of times on really important matters, tried to change laws when laws got in his way... and he is regarded as a safe caretaker until one of his culpable ministers takes over as PM.

https://www.thedailymash.co.uk/politics/ghost-unmasked-by-scooby-doo-gang-a...