So who is ‘extremely vulnerable’ and should be shielding?

On 16 March, ITV reported the Chief Medical Officer for England saying that advice would shortly be sent out to ‘vulnerable’ people who should be taking extra steps to protect themselves against COVID-19, namely by shielding themselves for twelve weeks. He specifically stated that this would broadly speaking be those advised to have the annual flu vaccine:

IMG_4629

The Times the next day published this handy chart on what you should do if you were in a specific group:

Screenshot 2020-03-30 at 12.54.14

The Times table, obviously based on Government briefing, introduced the concept of ‘serious underlying health conditions’ which was clearly intended to be different from ‘underlying health condition’.

Those adults advised to have the flu vaccine include:

Screenshot 2020-03-30 at 12.24.31

Ok, now bear with me. I’ve been looking for up-to-date figures on the numbers getting the flu vaccination annually. Public Health England said 25 million were eligible for free flu vaccinations in 2019. In the previous year about 70% of over 65s took up the vaccination; and 48% of those in an at-risk group and 45% of pregnant women in England. This meant about 7.5 million over-65s had the vaccination; 6.8 million of those in at risk groups. In Wales, a total estimated 868,668 people were vaccinated.

So if the 16 March definition given by Professor Whitty had been used, then many millions of people would have been asked to shield themselves. Shielding, remember means this ‘You are strongly advised to stay at home at all times and avoid any face-to-face contact‘. Any face-to-face contact. In more detail:

Screenshot 2020-03-30 at 13.26.31

The extract above is from the Guidance issued by the UK Government on 21 March on shielding people defined as ‘extremely vulnerable’.

Those defined as ‘extremely vulnerable’ are clearly a much smaller group than the vulnerable groups mentioned by Professor Whitty on 16 March. They are defined as:

Screenshot 2020-03-30 at 13.33.24

As an asthmatic, I looked for definitions of ‘severe asthma’. Last Monday, 23 March, I found guidance issued by Asthma UK following advice from the Department of Health and Social Care in the UK. This suggested severe asthma consisted in the following:

Screenshot 2020-03-30 at 13.39.52

The original guidance posted by Asthma UK suggested ‘a high daily steroid dose’ meant – for example – two puffs a day of the Seretide inhaler, which is my own prescription. (for those definitions, see for example this). I would not have defined my asthma as ‘severe’ before reading that – I cycle regularly and feel my asthma is under good control.

The NHS Digital Clinical algorithm used to identify ‘Shielded patients’ however defines severe asthma as follows: ‘Severe asthmatics are those who are frequently prescribed high dose steroid tablets.’ (in the small print, this includes for example prednisolone.I haven’t been prescribed that for over 40 years, after I had been hospitalised for my asthma). This is of course different from the Asthma UK guidance on what is meant by severe asthma, a term which Asthma UK accepts is open to interpretation.

Screenshot 2020-03-30 at 13.48.41

In the detailed explanation of the NHS Clinical Algorithm, you will find the following:

Screenshot 2020-03-30 at 13.52.40

So 19 Million people would have been captured by Professor Whitty’s original suggestion of the vulnerable who should be shielded: these are now classified as ‘at risk’. Now there is a group of ‘at high risk’ people amounting to 1.5 million. These ‘at risk’ and ‘at high risk’ groups roughly correspond to the ‘vulnerable’ and ‘extremely vulnerable’ categories. It is the ‘at high risk’ or ‘extremely vulnerable’ group that have been getting letters and in some cases texts from the NHS as announced last Monday. Letters should have been received by today if you are ‘extremely vulnerable’.

If you think you should be in the ‘extremely vulnerable’ or ‘at high risk’ group but have not been categorised as such, then if you live in England you can log in here to say so. The option to challenge your categorisation may exist in Wales but if it does I can’t find it in this.

19 million at risk or vulnerable. 1.5 million ‘at high risk’ or ‘extremely vulnerable’. To my mind, this just reinforces the lack of clarity in government messaging over the last fortnight.

 

 

Johnson, Churchill and Crisis Communications

My article on Johnson, Churchill and crisis communications was published in the New European yesterday. It was written and published before we knew the Prime Minister had contracted COVID-19, and I genuinely wish him a swift recovery. But that doesn’t invalidate what I wrote:

The UK Government’s coronavirus communications have been poor. Partly because of the apparent change of strategy – from the formation of ‘herd immunity’ at the risk of a large number of deaths to a stronger emphasis on social distancing and self-isolation. The initial strategy, heavily criticised and harder to explain, will unquestionably be the subject of Parliamentary and Public Inquiries in due course. Inquiries will also deal with the apparent delays in creating more ICU beds, ordering additional ventilators and protective equipment for front-line staff. For now, the priority is getting those problems sorted.

But the major problem has been the Prime Minister. The people taking key decisions at the centre of this unprecedented crisis are intelligent, hard-working and diligent, working under extreme pressure, at great pace and with facts and evidence that are being gathered in real-time. But the PM’s performance has not inspired confidence. Alastair Campbell, who knows a thing or two about crisis communications, published twenty recommendations for practical things the government should be doing. His key observation was the need for the Prime Minister to ‘narrate’ a strategy. Unlike his hero Churchill, Boris Johnson has failed in that. Even Monday’s address to the nation showed someone trying but failing to suppress his gung-ho bonhomie.

There are four key factors that can gleaned from the writings of Churchill’s contemporaries, people who served with him or watched him at close distance. They are

  • Clarity
  • Gravity
  • Preparation, and
  • Discipline

Clarity. Waffle won’t wash. Indeed, it confuses the message. Churchill could sometimes be prolix in his orations but he knew the importance of clarity and concision in the delivery of messages. Shortly after becoming Prime Minister in 1940, he wrote a minute to his War Cabinet headed ‘Brevity’.  It’s as relevant today as when it was written. ‘To do our work’, said Churchill, ‘we all have to read a mass of papers. Nearly all of them are far too long. This wastes time, while energy has to be spent in looking for the essential points.’ This was not a plea for recommendations without evidence – where needed, that should be given in an Appendix. The demand for brevity, to Churchill, wasn’t simply about the use of time. It was about getting clarity. This one-page memorandum ended ‘the discipline of setting out the real points concisely will prove an aid to clearer thinking.’

Gravity. Churchill didn’t treat the British people as idiots, setting out the severest challenges with honesty. He also used humour wisely. Sir Ian Jacob, Military Assistant Secretary to the War Cabinet, and later BBC Director-General, recalled ‘humour in debate was not precluded, provided it did not degenerate into levity.’ Churchill wouldn’t have offered ‘Operation Last-Gasp’ in a meeting or conference call as Johnson is alleged to have done with industrialists in discussions on ventilator manufacture. Churchill had strong views on the naming of key war-time operations, stressing that they should not be frivolous or boastful. He understood the dignity of state office. It wasn’t a game.

Preparation. Churchill was a ‘girly swot’. Jacob said ‘his passion for detail is well known’. What most impressed people about Churchill, Jacob recalled, ‘was the fury of his concentration’. The diaries of his Assistant Private Secretary, Jock Colville, are littered with references to his preparations for speeches. A frequent opponent, Aneurin Bevan, recorded that Churchill ‘prepared his work with care and polished and re-polished it.’ The Chief of the Imperial General Staff, Sir Alan Brooke, who frequently clashed with Churchill, recalled in his diaries that he often had to help with Churchill’s speech preparations:

the whole Cabinet table had usually been littered with segments of the speech which had been returned by various people with remarks of criticisms. He worked at tremendous pressure on these occasions.

Discipline. Not all Churchill’s speeches worked. But in the midst of crisis, Churchill understood the importance of discipline for getting his message across. Bevan recalled that Churchill’s speeches ‘advanced along a broad sweeping front, making this point, then another, paragraph by paragraph, a majestic progress.’ Clement Attlee explained how Churchill provided the narrative for the war effort. ‘If somebody asked me what exactly Winston did to win the war, I would say “Talk about it”’.

Clarity, gravity, preparation, discipline. Not words yet associated with the current Prime Minister whose slap-dash extemporising has delivered mixed messages. Where Macron, Merkel, Sturgeon, Varadkar and even Rishi Sunak have been clear and controlled, Johnson has jabbered.

Churchill of course didn’t face 24-hour news or real-time social media. But he knew the importance of message discipline in a crisis. The Prime Minister should re-read his own book on Churchill, particularly this: ‘Churchill’s speeches were a triumph of effort, and preparation.’ From now on, he has to stay scripted.

 

 

Leighton Andrews is Professor of Public Leadership at Cardiff Business School, and a former Welsh Government Minister.

 

 

 

 

This is a time for honesty.

Coronavirus Curriculum Planning 2020-1

This is essentially me thinking aloud about the four post-grad modules I am scheduled to teach next academic year. Two weeks ago I said that if I was still here in the autumn – and I am planning to be:

Whatever happens, if I am here in the autumn, I will I know be teaching the social, political and economic consequences of coronavirus on at least two postgrad courses I lead.

In fact, I now think I will be teaching it on all four modules. All my teaching, aside from guest lectures, is in the October-January period, so I need to start some outline preparation. Here goes as I brain-dump some initial course thinking in a public value business school.

Government from the Inside – From the Minister’s Viewpoint (PLT435)

You can find a link to the module overview here. It is essentially an overview of the Ministerial life, from appointment to leaving office. It looks amongst other things at Appointment and the first 100 days, Ministers in Cabinet, as departmental leaders, in the Chamber and Committee, working with and against the Opposition, Ministers and the Media, pressure groups and ministers, evidence for ministerial policy-making, leaving ministerial office. It covers UK and devolved ministerial life.I am planning a book for Palgrave Macmillan based on the course which I have now taught for the last three years.

Students are assessed through an end-of-term essay. These are on topics they choose and are always interesting. Last year one student elected to look at Norman Fowler and the Aids Crisis, which has some parallels with today’s crisis. If I took a coronavirus lens I guess I would look through the course at how the virus has disrupted the marking of Boris Johnson’s 100 days in office; how COBR (A) has worked in co-ordination, including with the devolved administrations, how scrutiny of evidence has developed in Parliamentary committees, how pressure group and media criticism has influenced ministerial policy, and the role of daily press briefings in crises, the collation of evidence in an emerging crisis and the building of ministerial discursive capacity, Opposition input in the crisis, and maybe some futurism about ministerial reputations in the crisis and their likely scorecards after leaving office.

I am already collating materials, from press reports to parliamentary inquiries and government documents, which includes much of the advice that went to SAGE. (To be fair to the UK government, a lot of material has been published in respect of the evidence base and their assumptions). There is also a considerable amount of material on managing crises in the interviews with former ministers on the Institute for Government’s Ministers Reflect series. No question then that coronavirus will feature on this module.

International Business Management (BST448)

This is one of the core modules on Cardiff Business School’s MSc. in International Management. I have been teaching this module for the last two years and it has had a significant ‘tech’ focus, which has enabled the exploration of themes around globalisation, based on my recent research. In postgrad terms it’s a large module with about 140 students, a very high proportion of them from China. Who knows how or if this will change next year? The COVID-19 outbreak has sparked all kinds of writing about the future of globalisation, networks, re-localisation, etc. The COVID-19 outbreak also lends itself to a straightforward introduction for management students to PESTLE analysis.

There are significant opportunities here obviously to look comparatively at governmental and political responses, business impacts in different sectors, the role of technology in surveillance of the disease (and obviously surveillance more generally), and how the disease may affect international business development, including global value chains. It may allow students to bring their own country by country observations to the forefront.

Think I will definitely be teaching COVID-19 and its impact on the the global economy this course, but it may require some re-writing.

Leading Policy and Delivery (BST652)

I was involved in co-developing our new part-time MSc in Public Leadership . This autumn I will be teaching the module about leading policy into delivery over three sessions. I guess that COVID-19 will become one of the cases that we will interrogate as it will be directly relevant to everyone’s immediate experience. Our students come from a variety of public service backgrounds.

Unlike the ministerial module above, the focus will be more about the impact on public service delivery. So I can see us covering its impact on the relationship between the making of policy and its implementation on the ground; thefeedback loops between frontline delivery and policy-making; collaboration between services,  both devolved and non-devolved; integration of third sector in delivery; what this means for target-setting, capacity- building, resilience planning, governance.

Much of this would have been discussed on the module in any case. But there is quite a lot to plan for here. And I think the agenda will expand as time goes by.

Strategic Planning and Innovation (BST680).

This year we began teaching a postgraduate Diploma in Healthcare  Planning in Wales. I am one of two academics teaching on the Strategic Planning and Innovation module. To a degree, our emphasis, as the NHS Wales Deputy Chief Executive, Simon Dean, said at Cardiff Business School in 2019, is that what matters most is the planning, not the plan. Though this was devised before the COVID-19 outbreak, we already had considered planning for unexpected emergencies and crises and ways in which governments did this in a variety of spheres, from terrorist outbreaks to a no-deal Brexit. COVID-19 forces consideration of previous planning exercises for pandemics.

This module from my perspective probably needs some adjustment but less overall than the others, as the key themes are there in outline, but need drawing out with reference to the current crisis, and the evidence materials published by the UK Government already mentioned above are directly relevant.

That was a brain-dump on behalf of my course planning. Now I need to allocate time for teaching preparation for each of these modules.

 

Coronavirus – Living well is the best revenge

As a 62 year-old asthmatic with ropey lungs I have been apprehensive about Coronavirus for some weeks, and the news from Italy over the last week or so intensified my worries.

Today, one conference at which I was to give a paper in April (Political Studies Association in Edinburgh) has been cancelled. Last week their expressed view was that they were going ahead. Cardiff University has now taken the decision on the other one where I was due to give a paper out of my hands – PUPOL in The Hague at Leiden University –, saying ‘all work-related travel outside the UK should be postponed until further notice unless it is essential.’ I suspect PUPOL would have been cancelled anyway.

We are waiting on the UK government’s decisions over closures and further social distancing. Obviously Ireland made its decision to close schools etc today. Yesterday, Denmark, where our son lives, took that decision.

My 90 year old mother has been in and out of hospital over the last four weeks, so that has been my main concern as I have been visiting her in hospital, and when she was out last week there were a series of medical and care calls to undertake, before she went back in on Sunday.

My mother’s care and the need to visit her in hospital means that I cannot do what Colin Talbot has done and self-isolate, or ‘cocoon’ as Colin prefers, but from what I know of Colin’s medical conditions they are much more serious than mine. But I have been giving active consideration to that, given the way COVID-19 targets the lungs. We haven’t been stockpiling toilet rolls but our cupboards and freezer have the necessary basics to avoid shopping if we had to. Today I noticed local shop-keepers wearing plastic gloves and using sanitiser after customers touched card machines and counters, and who can blame them.

We also have childcare responsibilities with our grand-children – days spent with them are a bonus to life.

I am currently due to give a lecture on Monday to 2-300 students as a guest lecturer on another course, but there is no reason why the materials couldn’t be delivered on-line, and that is the same case with a guest lecture the following week to a smaller number.

The charity I chair, the Cardiff City Community Foundation, has its annual Foundation year events over the weekend starting tomorrow, as we celebrate how Our Club Changes Lives. We have been reviewing all our activities – and our risks – over the last week in the context of the advice from Public Health Wales.

This is a year in which we were lucky enough to have a concentrated period of holidays in May and June – a wedding in Spain, an educational visit to Sicily, and then the Euros in Rome for which we are fortunate enough to have tickets. How many of these will now go ahead is anyone’s guess. UEFA is meeting to discuss whether the Euros are postponed for a year apparently.

Whatever happens, if I am here in the autumn, I will I know be teaching the social, political and economic consequences of coronavirus on at least two postgrad courses I lead.

If I am here in the autumn. I plan to be, but the truth is no-one knows what outcomes will be. I am sick of hearing about people who have died being described as elderly or having ‘underlying health conditions’. Every coronavirus death is a tragedy. No-one should be dehumanised and no death simply excused away as due to the individual being ‘elderly’ or having ‘underlying health conditions’. I have underlying health conditions. So do millions.

We are living with uncertainty, in a way that few of my generation and those younger have ever experienced. Indeed maybe only those with experience of living through the war have anything similar to compare it with.

I think the advice from the UK government will now change to a more intensified set of social distancing recommendations every few days. I have confidence in the scientists, but I am keeping an eye on what is being said in Italy in particular.

The declared number of cases is not the true number of cases, as the scientists said today. 500+ cases officially in the UK, but more like 5-10,000 in the population as a whole, and they are no longer going to be testing cases in the community, but keeping testing for those in hospital already.

They are, without saying it, planning for the worst, and unlike with swine flu and avian flu, where preparations were made for the worst case, we have practical evidence in Europe of what that worst case looks like.