Friday, April 17, 2020

COVID 19 - work in progress

Like many of us in public health, I've been rather busy with COVID-19. I thought it might be useful to bring together what I've been involved in in one place:

Papers in scientific journals:

15.          Patel P, Hiam L, Sowemimo A, Devakumar D, McKee MEthnicity and COVID-19BMJ 2020; 369: m2282 
17.          Oh J, Kavanagh MM, Gottschalk K, Subramanian SV, Shibuya K, Hirschhorn LR, Alonso C, Torres I, Awoonor-Williams K, Minh HV, Bawah AA, Tran H, Kachur SP, Sáenz R, Barrios OA, Kwon S, Nam EW, Choi JW, Lee J-K, McKee M, Gostin LO. Announcement of launching the JGHS Commission on COVID-19 Response. J Global Health Science 2020; 2: e20
18.          Roberts CM, Levi M, McKee M, Schilling R, Lim WS, Grocott M. COVID-19: a complex multi-system disease Br J Anaesthesia 2020: DOI:https://doi.org/10.1016/j.bja.2020.06.013
19.          Han E, Chiou ST, McKee M, Legido-Quigley H. The resilience of Taiwan's health system to address the COVID-19 pandemic. EClinicalMedicine. 2020 Jun 27:100437. 
20.          Toffolutti V, McKee M, Stuckler D. Is theCOVID-19 pandemic turning into a European food crisis? Eur J Publ Health 2020; doi:10.1093/eurpub/ckaa101

21.           McKee M, Gugushvili A, Koltai J, Stuckler D. Are Populist Leaders Creating the Conditions for the Spread of COVID? Int J Health Pol Management 2020: doi: 10.34172/ijhpm.2020.124

22.          Rajan S, Cylus J, McKee M. What do countries need to do to implement effective ‘find, test, trace, isolate, support’ systems? J Roy Soc Med 2020; 113: 245-50

23.           McKee M. England’s PPE procurement failures must never happen again. BMJ 2020: 370: m2858

24           Shanks S, Van Schalkwyk MCI, McKee M. Covid-19 exposes the UK’s broken foodsystem. BMJ 2020; 370: m3085

25.      Gugushvili A, Koltai J, Stuckler D, McKee M. Votes, populism, and pandemics. Int J Publ Health 2020: https://doi.org/10.1007/s00038-020-01450-y

26.           McKee M. Learning from success: how hasHungary responded to the COVID pandemic? GeroScience 2020: https://doi.org/10.1007/s11357-020-00240-x

27.      Vanoni M, McKee M, Bonell C, Semenza J, Stuckler D. Using volunteered geographic information to assess mobility in the COVID-19 pandemic context: cross-city time series analysis of 41 cities in 22 countries from March 2nd to 26th 2020. Globalization Health 2020 Sep 23;16(1):85.

28.     Han E, Tan MMJ, Turk E, Sridhar D, Leung GM, Shibuya K, Asgari N, Oh J, García-Basteiro AL, Hanefeld J, Cook AR, Hsu LY, Teo YY, Heymann D, Clark H, McKee M, Legido-Quigley H. Lessons learnt from easingCOVID-19 restrictions: an analysis of countries in Asia Pacific and Europe. Lancet 2020:  396: 1525-1534 

29           Agius RM, Robertson JFR, Kendrick D, Sewell HF, Stewart M, McKee M. Covid-19 in the workplace. BMJ 2020; 370: m3577

30         Crozier A, Rajan S, McKee M. Fixing England’s COVID-19 response: learning from international experience. J Roy Soc Med 2020: 113: 422-427

31               Kontis V, Bennett JE, Rashid T, Parks RM, Pearson-Stuttard J, Guillot M, Asaria P, Zhou B, Battaglini M, Corsetti G, McKee M, Di Cesare M, Mathers CD, Ezzati M. Magnitude, demographics and dynamics of the impact of the first phase of the Covid-19 pandemic on all-cause mortality in 21 industrialised countries. Nature Med 2020: 26: 1919-1928

32                McKee M, Stuckler D. Scientific divisions on covid-19: not what they might seem. BMJ 2020;371:m4024

33                Rajan S, Comas-Herrera A, McKee M. Did the UK government really throw a protective ring around care homesin the COVID-19 pandemic? J Long-Term Care 2020; 2020: 185-195.

34        Palafox B, Renedo A, Lasco G, Palileo-Villanueva L, Balabanova D, McKee M. Maintaining population health inlow- and middle-income countries during the Covid-19 pandemic: Why we should be investing in Community Health Workers Trop Med Int Health 2020: doi: 10.1111/tmi.13498.

35               Lloyd-Sherlock P, Sempe L, McKee M, Guntupalli A. Problems of data availability and quality for Covid-19 andolder people in low and middle-income countries. Gerontologist 2020: gnaa153. 

36                Burgess RA, Osborne RH, Yongabi KA, Greenhalgh T, Gurdasani D, Kang G, Falade AG, Odone A, Busse R, Martin-Moreno JM, Reicher S, McKee M. The COVID-19 vaccines rush: participatory communityengagement matters more than ever. Lancet 2020; 397: 8-10.

37.     McKee M, Rajan S. What can we learn from Israel’s rapid roll out of COVID19 vaccination? Israel J Health Pol Res 2021; 10: 5.

38.     Baum F, Freeman T, Musolino C, Abramovitz M, De Ceukelaire W, Flavel J, Friel S, Giugliani C, Howden-Chapman P, Huong NT, London L, McKee M, Popay J, Serag H, Villar E. Explaining COVID-19 performance: Whatfactors might predict national responses? BMJ 2021; ;372: n91

39.      Crozier A, Rajan S, Buchan I, McKee M. Put to the test: useof rapid testing technologies for covid-19. 2021;372:n208

40.                Barlow P, van Schalkwyk M, McKee M, Labonte R, Stuckler D. COVID-19 and the collapse of global trade: what policymakers need to know to build an effective public health response. Lancet Planetary Health 2021; 5: e102–07

41.                Burgess RA, Osborne RH, Yongabi KA, Greenhalgh T, Gurdasani D, Kang G, Falade AG, Odone A, Busse R, Martin-Moreno JM, Reicher S, McKee M. The COVID-19 vaccines rush: participatorycommunity engagement matters more than ever. Lancet 2021; 397: 8-10.

42.              Van Schalkwyk M, Maani N, McKee M. Publichealth emergency or opportunity to profit? The two faces of the COVID-19pandemic. Lancet Diab Endocrinol 2020: https://doi.org/10.1016/ S2213-8587(21)00001-2

43        Murphy A, Mbau L, McKee M, Hanson K, Torreele E. Can we do for other essential medicines what we are doing for the COVID-19 vaccine? BMJ Global Health. 2021;6:e005158.

44         McKee M. The UK’s PPE procurement scandal reminds us why we need ways to hold ministers to account. BMJ 2021; 372: n639

45        Szocska M, Pollner P, Schiszler I, Joo T, Palicz T, McKee M, Sohonyai A, Szoke J, Toth A, Gaal P. Putting (Big) Data in Action: Saving Lives with Countrywide Population Movement Monitoring Using Mobile Devices during the COVID-19 Crisis. Scientific Rep 2021; 11: 5943McKee M, Gugushvili A, Koltai J, Stuckler D. Are Populist Leaders Creating the Conditions for the Spread of COVID? Int J Health Pol Managenent 2020: doi: 10.34172/ijhpm.2020.124

 46       Turk E, Durrance-Bagale A, Han E, Bell S, Rajan S, Lota MMM, Ochu C, Lazo Porras M, Frumence G, McKee M, Legido-Quigley H. International experiences with co-production offer lessons for COVID-19 responses. BMJ 2021; 372: m4752

47        Gugushvili A, McKee M. The COVID-19 Pandemic and War. Scand J Public Health 2021: doi: 10.1177/1403494821993732P1             

48        Mansfield KE, Mathur R, Tazare J, Henderson AD, Mulick A, Carreira H, Matthews AA, Bidulka P, Gayle A, Forbes H, Cook S, Wong AYS, Strongman H, Wing K, Warren-Gash C, Cadogan SL, Smeeth L, Hayes JF, Quint JK, McKee M, Langan SM. COVID-19 collateral: Indirect acute effects of the pandemic on physical and mental health in the UK. Lancet Digital Health 2021: doi.org/10.1016/ S2589-7500(21)00017-0               

49         Kluge H, McKee M. Vaccinating the European Region: an unprecedented challenge. Lancet 2021: oi.org/10.1016/PII

50        van Schalkwyk MC, Maani N, Cohen J, McKee M, Petticrew M. Our Postpandemic Word: What Will it Take to Build a Better Future for People and Planet? Milbank Q.  2021. https://doi.org/10.1111/1468-0009.12508    

Pre-prints

1.        Jonathan Koltai, Veronica Toffolutti, Martin Mckee, David Stuckler. Changing probability of experiencing food insecurity by socioeconomicand demographic groups during the COVID-19 pandemic in the UK. medRxiv 2020.11.10.20229278; doi: https://doi.org/10.1101/2020.11.10.20229278


Papers in press


Resources:
Ramon Martinez, Shah Ebrahim, Lucas Sempe and Martin McKee. Potential impact of COVID-19 on human mortality tool. This allows you to apply the age specific mortality seen in Italy or China to age distributions worldwide
Link to description
Our monitor is bringing together structured reports on how countries across Europe are responding to the COVID-19 pandemic. You can select themes and countries to generate your own pdf. We are also adding thematic analyses, for example on testing practices across countries.

I am a member of the Independent SAGE, convened by Sir David King. Our first report was published on 12th May 2020 
Our second report, on reopening of schools, is here
Our third report on FTTIS is here
Other
Michael RobertsMarcel LeviRichard SchillingWei Shen LimMichael PW GrocottMartin McKee. Covid-19: a complex multisystem clinical syndrome. BMJ Opinion 
Raymond Agius, John RobertsonMarcia StewartDenise KendrickHerb SewellMartin McKee Covid-19: Rigorous investigation of healthcare workers’ deaths is indispensable.  BMJ Opinion 
Media (selected)
Interviews:
Washington Post 23rd March
BBC Radio Ulster: 24th March , 2nd April
Daily Telegraph 6th March
BBC Radio 4 The World Tonight 13th April
Sky News 15th April
Toronto Globe and Mail 3rd April;  20th April
Sydney Morning Herald 4th May
Därför kan en ekonomisk kris skada folkhälsan mer än det nya coronaviruset. [Therefore, an economic crisis can harm public health more than the new corona virus] Dagens Nyhater 20th April
Tragiczny błąd Zachodu w walce z koronawirusem Rzeczpospolita [In Polish: A tragic mistake by the West in the fight against coronavirus] 4th May
Discussions/ podcasts
BBC World Service The Real Story. Discussion with Zeke Emanuel, Ben Cowling, Emma Frans and me. 17th April
The public health response to COVID19. BMJ podcast 
BBC Radio 4 The Briefing Room. 23rd April 
BMJ podcasts
Blogs

Webinars:
Letters to newspapers

Letter to Financial Times critiquing Oxford study


























Letter to Financial Times calling for a public inquiry:


Friday, August 17, 2018

E-cigarettes - more evidence of English exceptionalism

The House of Commons Science and Technology Committee has just published a report on e-cigarettes. Those involved in tobacco control outside England are amazed at its conclusions although not entirely surprised as the England has long been an international outlier on this issue, far out of step with the rest of the world. For example, two major reports, from the US National Academies ofScience and, only a few days ago, from Australia, highlight how much is not known. The American Heart Association agrees that " the potential health effects unknown, especially in long-term users" and has made a series of recommendations that are almost the opposite of those in the Commons report. And it's not just in the Anglophone world. leaders of the European Respiratory Society recently responded to a paper on e-cigarettes in England saying "(A) There is little evidence that e-cigarettes are an aid to smoking cessation and much evidence that tobacco manufacturers are advertising e-cigarettes as a bridge to starting nicotine and as a vehicle for long term continuation”; and “(B) no-one, expert or otherwise, can credibly assert that e-cigarettes are safer than tobacco in the long term, given that they contain a whole new tranche of unregulated and unstudied compounds being inhaled into the lung."
It is especially astonishing that the 95% safer figure is used, given that it has no credibility internationally. There are serious questions about the funding of the meeting it came from and it is simply impossible to know how safe a product is when it has only been used widely for a relatively short time. It took decades to discover the health effects of smoking. 
The World Health Organisation has said explicitly that a precise figure cannot be given, referring to "Unsubstantiated or overstated claims of safety and cessation". Also, as reported earlier this week in a study from Birmingham, new evidence is appearing weekly raising concerns about safety.
It is equally astonishing to see the claim that they are a proven smoking aid given the recent publication of a large controlled trial in the New England Journal of Medicine concluding that "Among smokers who received usual care (information and motivational text messages), the addition of free cessation aids or e-cigarettes did not provide a benefit. ". Moreover, there is now lots of evidence from observational studies that they reduce quitting.
The suggestion to increase nicotine is especially worrying given that organisations such as ASH have argued that the UK is safe from the rapid increase in use of Juuls by schoolchildren seen in the USA because of the lower levels permitted here. The report simply dismisses concerns such as that by the former chair of the American Academy of Pediatrics Tobacco Consortium, who has said “Juul is already a massive public-health disaster". But then, the report ignores the considerable evidence that these products are a gateway to smoking.
Fortunately, other countries are not following England's direction, despite massive pressure from a very well funded Big Tobacco operation. Instead, they are waiting for the results on our giant experiment on our people.

Friday, November 17, 2017

The EHIC post Brexit: The devil is in the detail

The House of Lords Home Affairs Committee has a sub-committee on the EU. It is an extremely impressive group, chaired by a former head of the diplomatic service, and with a former chief executive of the NHS among its numbers. I was asked to give evidence on the prospects for retaining the European Health Insurance Card post Brexit. What other arrangements does the EU have with third countries? Are there arrangements from before we joined the EU that we could revive?
This involved a lot of homework - for example, dredging through the National Archives to find ancient treaties. That was a fascinating exercise. Several were with countries that no longer exist, such as Czechoslovakia (although in that case it seems that David Davis is unaware that it split in two in 1993), Yugoslavia, and the USSR. The wording revealed how far we have come. Many of the treaties talked of how, if a national of one country was residing in another, he would be entitled to something, as would his wife.  Clearly, the possibility of a woman ever working abroad was unimaginable to them.
I've written a blog about what I discovered on the BMJ website. But to cut a long story short, it is clear that, once again, UK ministers are living in cloud cuckoo land. Their remarks reveal a profound ignorance of even the most basic aspects of how the EU works. I cannot see any prospect of retaining the EHIC given the UK government's red lines.
No wonder our European neighbours are now planning for the worst. Until now, they persisted in the belief that the UK government could not be so stupid. But now they realise that it is. And it is both tragic and embarrassing.

Wednesday, November 01, 2017

A running commentary

The Brexit negotiations continue - I deliberately do not use the word progress. It is now abundantly clear that the UK is totally unprepared. The Cabinet is hopelessly divided. Weekly, politicians make statements revealing their deep ignorance of how the EU works. The general view is that if they wait long enough, someone else will find a solution.

The Prime Minister has said that she won't provide a running commentary. She seems strangely shy about sharing the news about what she seems to think will be an amazing success, refusing to publish her government's assessments of the impact of Brexit. This may not matter - even the ministers in the department that is meant to be negotiating Brexit haven't read them - and can't even confirm they actually exist. Still, if she isn't willing to, I thought I could help with some observations from time to time. So as well as the blogs mentioned in previous posts here, I've added a few more. I hope you find them interesting.

BMJ blogs:

UK in a changing Europe:

Tuesday, April 04, 2017

The sound of ideology smashing into the wall of reality is echoing around Whitehall

The UK government has issued its latest Brexit White Paper. Well, some of it is white. Five of the 44 pages are completely blank. Another 5 only have blue rectangles. One wonders how much time was spent in deciding what shade of blue was used. It must have been light relief from the much more difficult task of thinking of words to include. Yet it does say something. It seems to recognise that Brexit will be much more difficult than the Leavers thought, and many will be very disappointed. But it also shows that the UK government still has very little clue if how to proceed.
My take on it can be seen in my latest BMJ blog, which you can read here.

Thursday, March 30, 2017

So Theresa May has triggered Article 50. It didn't go down well. First, she called for talks on the UK's exit from the EU to proceed in parallel with those on a free trade deal. Clearly she hadn't been listening to what everyone else had been saying for months. It isn't going to happen, as Angela Merkel (and many others) quickly pointed out. Then she issued a veiled threat - be nice to us or we will stop co-operating on security. At a time when all European countries face a severe threat, this is not good timing. And her obvious disregard for the interests of Scotland, Wales, Northern Ireland and Gibraltar greatly increases the likelihood that, in 10 years time, it will be England alone outside the EU.
Maybe we could be more reassured if we felt that the UK government had some plan for how to proceed. Sadly, as I noted in a recent blog for the BMJ, it is now all too apparent that it doesn't. Indeed, listening to the news today simply confirmed my suspicion. Those who support Brexit simply don't understand the EU and our relationship with it, something that has taken 40 years to develop and, by all accounts, will take 40 years to disentangle ourselves from.
Can the notification of Article 50 be revoked. Certainly our European partners think so. And for this we should be very grateful because, sometime in the next few years, the UK will hit the wall we call reality. And we may be very grateful for an escape from this insanity.

Saturday, February 04, 2017

Brexit White Paper - or should it be Blank Paper

I've written a new blog on the Brexit White Paper on the BMJ website. You can read it here. As you will see, I was quite amazed that any government would have the audacity to produce such an appalling document and pass it off as a something as serious as a government White Paper. It adds almost nothing to Theresa May's Lancaster House speech, contains factual errors, and includes no serious analysis of the challenges ahead. It has all the realism of a 5 year old writing to Santa Claus.
Others have noted how, by reading the metadata on the HTML version, one can see that it was only finished at 4 am in the morning it was published. One feels that it may only have been started the evening before.
Those wanting to read more (and after reading the White Paper, anyone with even a passing interest in Brexit is likely to want much more) should also look at Steve Peer's excellent analysis here. There is also a great thread by on twitter by Schona Jolly, another perceptive observer of these things.


Tuesday, September 13, 2016

Brexit 2 months on

It gets worse. Once, when a UK cabinet minister spoke on his brief at the despatch box in the House of Commons it was assumed that it was government policy. No more. Of course, the blame doesn't lie entirely with the Secretary of State for Exiting the EU. The problem is that there is no government policy. Or indeed, no prospect of developing one.
It must now be clear to everyone that:
a) the UK government lacks the capacity to actually leave the EU (unless it wants to just walk away in the desperate hope that something will turn up, which it won't)
b) the arguments advanced by the Leave campaign were blatant lies
c) there is no easy way out - Theresa May can't even call an election and lose it, leaving someone else to clean up the mess as the lamentable state of the Labour Party means that she would win
I've written a few new blogs that try to set out some of the issues. They are pretty depressing. But they may inject a degree of reality to a debate characterised by political demonstrations of optimism that make one wonder if the speakers inhabit the same world as the rest of us.

Brexit - the confusion continues. BMJ 8th September 2016

"Brexit means Brexit" Health Policy & Planning, 7th September 2016

Sunday, July 03, 2016

The EU referendum and beyond

So now we have a result. And it is not good. A brave politician has been murdered. We have had months of blatant lies by those supporting the Leave campaign. We have had a massive upsurge in racist attacks. We now know that some politicians were willing to bring our country to the brink of disaster in pursuit of their own personal agendas. The two main political parties are rudderless. Research collaborations are already being damaged. Citizens from other EU countries are terrified.

We show no evidence of learning the lessons of history, whether they are from the 1930s in Europe or from the last time a UK government launched a major initiative without a plan, as we will hear in the Chilcot Report in a few days.

Those who supported Leave are revealing massive optimism bias. They make Voltaire's Dr Pangloss look like a pessimist. They think we can negotiate trade deals rapidly, despite our lack of negotiators. They show no sign of appreciating the crisis we face. Yet there is no excuse - they just need to look at the Swiss situation. But of course, they think they will be different. This is verging on teh delusional.

None have a clue what to do. The unwillingness of those who have at least some insight to trigger Article 50, which would start the clock ticking, is revealing. See David Allen Green (aka Jack of Kent) for the best analysis.

The only reassuring thing is that some day, they will realise the complexity of what they seek and that it is likely to paralyse the parliamentary process for years. But the damage done by then will be enormous.    

I've written a few blogs on the fallout from the EU referendum are on the BMJ site:


24th June 2016: We have no idea what will come next, but it won’t be good

27th June 2016:  Brexit and health—the confusion grows

30th June 2016: Fair and balanced? Science in a post fact society


Thursday, May 02, 2013

Why are people losing faith in conventional politics?


People in many countries are losing faith in politics as usual. Some are returning to the politics of an earlier age, voting for neo-fascist parties such as Golden Dawn in Greece and Jobbik in Hungary. Elsewhere, those calling for transparency and direct democracy, whereby those elected should represent the people rather than powerful vested interests, are achieving success. The most newsworthy example was in Italy, where a party led by a professional comedian emerged as the largest single party in the 2013 general election although elsewhere, the Pirate Party, which originated in Sweden, is seeing electoral success in a growing number of countries, with Iceland only the most recent. In the England, the UK Independence Party is now in third place in opinion polls, despite revelations from e-mails exchanged by its senior officers that it is so desperate to have semi-coherent policies on a range of topics that it is considering buying them from sympathetic think-tanks. 
History, especially that of Europe in the first half of the twentieth century, reminds us that a failure by politicians to manage an economic crisis can lead to a rejection of conventional political parties so, to some extent, what is happening now should not be a surprise. But history also reminds us that the importance of these developments should not be underestimated. No matter how justified it may seem to describe parties such as UKIP as being composed of “loonies and fruitcakes”, this rather misses the reason why a disillusioned electorate has lost faith in conventional politics.
Two recent health-related events typify this view. The wave of revulsion that followed the shooting of 20 children and six staff in Sandy Hook Elementary School, in Connecticut, seemed to many people to be a game changer. The National Rifle Association attracted ridicule when it suggested that the best way to prevent more deaths in school shootings was to arm teachers. Opinion polls shows overwhelming support for tighter gun control measures, with 92% supporting the closure of loopholes that enable those buying firearms at gun shows to avoid background checks. Yet, when even such a modest measure such as this reached the Senate, it was defeated. 43 of the 46 senators voting against it had received campaign donations from the National Rifle Association. They found every excuse possible, no matter how incredible, to justify their failure to act against products responsible for the murders of over 8,000 Americans every year.  Having striven relentlessly to prevent any research that might challenge their position being undertaken, they ignored or dismissed what did exist, such as that showing a clear link between the laxity of state-level gun control laws and shootings. Bizarrely, a few days later, many of the same senators, who had rejected what they saw as intrusive surveillance by the federal government, rushed to condemn the FBI for failing to identify the Boston bombers before they acted.
About the same time, the upper chamber of the UK parliament was debating another health-related matter, the regulations requiring NHS services to be opened to competition. Ministers had offered copious reassurances that the Act, from which the regulations flowed, meant something other than what it plainly said. When the regulations confirmed its true meaning they claimed it was a mistake and, after scattering a few words such as integration almost at random, claimed to have fixed it. Legal opinion, not refuted by the government’s response that sidestepped the key issues, confirmed that the revised version was effectively unchanged. A major campaign was launched to ensure that peers were aware of this and the concerns of by health professionals and their representatives, some of whom seemed finally to have woken up to the threat being posed. Yet as in the US Senate, the government dismissed the evidence. A subsequent detailed legal analysis suggests that the speech by the minister introducing the regulations was incorrect in almost every respect. Despite overwhelming opposition by those who had studies the provisions, the government was successful, leaving those responsible for managing the NHS struggling to reconcile the regulations with ministers’ stated intentions. Quite why so many peers supported this obviously flawed legislation remains unclear but, as with the US Senate, a growing number of people are asking questions about the financial links between the private healthcare industry and some of the most eloquent supporters of the Act and the subsequent regulations.
 Politicians are meant to represent the views of the people, not powerful vested interests. Unfortunately, at times, they seem to echo the suggestion by Bertolt Brecht when he observed that, as the East German communist party had lost the confidence of the people, “would it not be simpler if the government simply dissolved the people and elected another?” Maybe they should reflect on this if they don’t want to join the Communist Party of the DDR in the dustbin of history. 

Wednesday, December 26, 2012

Hinchingbrooke - a (very minor) correction


Mr Birrell has, correctly, pointed out that I was mistaken in saying that the Public Accounts Committee had condemned the franchising arrangements at Hinchingbrooke Hospital. In fact, the Committee has yet to issue a final report. I should instead have said that members of the Committee had condemned it. I was thinking, in particular, of the closing comments of one of their members in their report of evidence taken: “I have to say, this should never ever happen again, because it is a financial disaster for value for money and for taxpayers.
I should also have mentioned the report into the franchising by the National Audit Office, which was the basis of the Committee’s hearing. Although measured in its wording, concludes that “The Authority should work with the Department to undertake a formal lessons learned process before agreeing any further franchise agreements.” This is on the basis of a long catalogue of problems, including a lack of clarity about transfer of risk and what measures of success were being used. One of the Committee members, used to reading these reports, describes it as “probably the worst report of financial incompetence in the NHS that we have seen. The chair noted that “I haven’t read a Report as bad as this on the health service. This is probably the worst.”
The views of the members suggest a fairly consistent tone of incredulity, such as “this report is chock-a-block full of people saying, "Never before anywhere in the NHS has this level of savings been achieved." McKinsey, who are probably the consultants who are around the NHS more than anybody, say that they think it is unachievable. We accept that it is early days. We know from Mr Parsa that they have not got to where they planned to be when they put the bid in to you. We know from the document here that they added 25% savings in at the last minute to give you a viable bid that you could accept. You seriously sit here and think that that will be achieved? You are seriously doing that?
Of course, as the evidence presented to the Committee and the NAO report indicate, there are many serious concerns about the franchising process, and not just the fact that Circle has a get out clause if it racks up excessive losses. But then, maybe this is unsurprising, given the description of the calculation of risk in public-private partnerships as "pseudo-scientific mumbo-jumbo".
I do hope that this has put the record straight. The Committee has not yet reached a considered conclusion on the Hinchingbrooke franchise but, I would suggest, it is already pretty clear what it is likely to be.