A story too familiar for comfort

On 4 January the British newspaper the Guardian published an insightful article by its health policy editor Denis Campbell: https://www.theguardian.com/society/2022/jan/04/nhs-is-in-crisis-but-the-roots-go-much-further-back-than-omicron?CMP=Share_AndroidApp_Other.

Campbell is an experienced journalist. He’s been writing for the Guardian and its sister weekly the Observer about the United Kingdom’s National Health Service (NHS), public health and medicine since 2007.

On this occasion his focus is on the devastating impact on the NHS of the highly transmissible omicron variant of Covid-19. To call it a crisis feels like an understatement.

Omicron is rampaging through the UK and causing massive destruction in the NHS, including out-of-control hospitalisations. The NHS’s dedicated workforce from general practitioners to ambulance drivers to health professionals in hospitals are overwhelmed as well as many being widely infected themselves.

The ultimate paragraph

But, as a good journalist should, Campbell goes further. Omicron’s devastation can’t be seen it isolation. The roots of this crisis that has been imposed on the NHS go back much further.

This is well summarised in the journalist’s following concluding paragraph:

Today’s immediate, escalating NHS crisis has long roots, which are also political roots. Years of decisions by David Cameron, Theresa May and Boris Johnson, especially their inaction on staffing, left it enfeebled and woefully underprepared for this level of extreme pressure, which the critical incidents and unavailability of ambulances dramatically illustrate. The service’s many supporters can only hope that it does not break altogether in the coming days.

Boris Johnson: A mix of callousness and incompetence

The roots of the crisis

Johnson’s leadership is characterised by a deadly combination of callousness and incompetence. But the roots of the crisis predate him. These long roots can best be described as woeful neglect of the NHS workforce.

Is there not something too familiar for comfort about woeful workforce neglect? Is this more than David, Theresa and Boris? In New Zealand, particularly since 2009, successive National and Labour led governments have also woefully neglected the health workforce employed by district health boards (DHBs) responsible for the provision of healthcare to geographical defined populations.

Health professional shortages are prevalent across the spectrum in all DHBs. They include medical specialists (nearly 25%), nurses and a large range of other allied professional groups such as psychologists, radiation therapists and physicists.

This is what Jacinda Ardern’s government inherited after the 2017 general election. Continuing the previous woeful neglect is how it responded. The only exception was nurses but this was limited. It only happened because of a successful collective bargaining campaign from their union, the New Zealand Nurses Organisation, which won the hearts and minds of  the public. Further, although still early days, substantive improvement has yet to materialise.

Consequently both the United Kingdom and New Zealand respectively had excessively overworked and fatigued (many burnt out as well) NHS and DHB workforces when the coronavirus pandemic first arrived in early 2020. Both Johnson and Ardern inherited this situation but both continued the woeful neglect response.

Contrasting outcomes

The outcomes for both countries could not be more contrasting. The best indicator of the effectiveness or otherwise is the mortality rate per one million population. As of 6 January, for the world as a whole had 695 deaths per million. Compare this with 2,194 in the United Kingdom. Then compare both with New Zealand’s 10 per million.

The explanation is easy. New Zealand followed the science (mostly) with its zero tolerance elimination strategy. The UK government’s response was callous and incompetent implementation of the much less effective alternative mitigation strategy. It included ignoring or delaying actioning the advice of science. Indecisiveness is a generous description.

Jacinda Ardern: kind and followed the science

New Zealand’s public health measures were fit for purpose (public safety); the UK’s were fit for high mortality.

But along comes omicron

But New Zealand is still vulnerable with the arrival of the omicron variant. At the moment (touch wood) it is being held at the border. Our position is also helped  by having one of the highest vaccination rates for adults and teenagers in the world.

But, unless the government significantly slows down the arrivals tap and strengthens protective border entry requirements, omicron will get into the community. It would make a big difference if the vaccine rollout for 5-11 year olds was well underway before this happens.

The omicron experience around the world including Australia, North America, the UK and Europe is horrific, not just the massive daily infections but also the huge influx of hospital admissions.

Owing to omicron’s high transmissibility (much higher than the highly transmissible delta variant), if or when it enters communities hospitalisations in Aotearoa will go through the roof. Vaccination rates and good public health measures should mitigate somewhat (the extent to which is unknown).

But it is difficult not to see our public hospitals and those who work in them being overwhelmed in terms of capacity and personal health. Labour’s continuation of National’s woeful neglect of this remarkable workforce will significantly worsen such a disaster.

Too much familiarity

The UK’s response to the pandemic was callous and incompetent. Its approach to its health workforce was unkind and uncompassionate. New Zealand’s response to the pandemic was kind and competent. But its approach to its health workforce was also unkind and uncompassionate.

What makes things worse is that both governments are intending to restructure their health systems in the midst of the pandemic. Now that really is shared lunacy. Too much familiarity for comfort indeed!