Thursday, May 07, 2020

The very model of a modern scientific man

Your humble Devil was thoroughly amused by Neil Ferguson's fall from grace, and is very pleased to have found the time to outline Ferguson's manifest and repeated failings—for posterity, you understand.

And it seems that the media scrutiny of Ferguson's sordid personal life has put the wind up some of the government's scientific advisers...
One scientific adviser to the government said Ferguson’s resignation had created “an awful lot of concern” and that the mood in the community was “very depressed”. The events revealed how university academics who lent their advice to government were having to cope with an increasingly difficult situation, the adviser added.

“He’s an academic researcher. He doesn’t make decisions. He’s not paid for any of this. We are being drawn into a political situation which is very unpleasant,” they said.
Oh dear, what a pity—how sad. Hey, science bods—you know you might avoid this kind of media scrutiny? Yes, that's right: don't take political appointee jobs and refuse the fat taxpayer-funded salaries. You don't want to be caught up in politics? Then don't play at politics.

Are these people simple, or what?

In the meantime, a programmer has finally got around to looking at the Imperial College modelling code—and her assessment is not pretty. [Emphasis mine—DK]
I wrote software for 30 years. I worked at Google between 2006 and 2014, where I was a senior software engineer working on Maps, Gmail and account security. I spent the last five years at a US/UK firm where I designed the company’s database product, amongst other jobs and projects. I was also an independent consultant for a couple of years.
So, a reasonably credible source then. I wonder what she found? Let's cite some choice extracts from the assessment, shall we?
Clearly, Imperial are too embarrassed by the state of it ever to release it [the original model code] of their own free will, which is unacceptable given that it was paid for by the taxpayer and belongs to them.

Due to bugs, the code can produce very different results given identical inputs. They routinely act as if this is unimportant.

[...]

Investigation reveals the truth: the code produces critically different results, even for identical starting seeds and parameters.

I’ll illustrate with a few bugs. In issue 116 a UK “red team” at Edinburgh University reports that they tried to use a mode that stores data tables in a more efficient format for faster loading, and discovered – to their surprise – that the resulting predictions varied by around 80,000 deaths after 80 days...

[...]

Because their code is so deeply riddled with similar bugs and they struggled so much to fix them that they got into the habit of simply averaging the results of multiple runs to cover it up… and eventually this behaviour became normalised within the team.

[...]

Although the academic on those threads isn’t Neil Ferguson, he is well aware that the code is filled with bugs that create random results.

[...]

Imperial are trying to have their cake and eat it. Reports of random results are dismissed with responses like “that’s not a problem, just run it a lot of times and take the average”, but at the same time, they’re fixing such bugs when they find them. They know their code can’t withstand scrutiny, so they hid it until professionals had a chance to fix it, but the damage from over a decade of amateur hobby programming is so extensive that even Microsoft were unable to make it run right.

[...]

The Imperial code doesn’t seem to have working regression tests. They tried, but the extent of the random behaviour in their code left them defeated.

[...]

Much of the code consists of formulas for which no purpose is given. John Carmack (a legendary video-game programmer) surmised that some of the code might have been automatically translated from FORTRAN some years ago.

[...]

This code appears to be trying to calculate R0 for “places”. Hotels are excluded during this pass, without explanation.

[...]

R0 is both an input to and an output of these models, and is routinely adjusted for different environments and situations. Models that consume their own outputs as inputs is problem well known to the private sector – it can lead to rapid divergence and incorrect prediction.

[...]

Despite being aware of the severe problems in their code that they “haven’t had time” to fix, the Imperial team continue to add new features; for instance, the model attempts to simulate the impact of digital contact tracing apps.

Adding new features to a codebase with this many quality problems will just compound them and make them worse.
Yikes. And the conclusion...?
All papers based on this code should be retracted immediately. Imperial’s modelling efforts should be reset with a new team that isn’t under Professor Ferguson, and which has a commitment to replicable results with published code from day one.
Well, I think that this fucking debacle goes some way to explaining why Ferguson's models have been such a complete and utter failure from the get-go.

And let us remind ourselves that our government were stupid enough to believe this fucking team of charlatans, and that they are busy cratering the economy on the strength of a computer "model" (I use the term advisedly) that produces complete garbage.
On a personal level, I’d go further and suggest that all academic epidemiology be defunded. This sort of work is best done by the insurance sector. Insurers employ modellers and data scientists, but also employ managers whose job is to decide whether a model is accurate enough for real world usage and professional software engineers to ensure model software is properly tested, understandable and so on. Academic efforts don’t have these people, and the results speak for themselves.
Indeed they do.

It's odd though. There's something at the back of my head, something niggling at me—a real sense of familiarity about this situation...

Where ales have we encountered a commentary on a computer model that has huge political and economic consequences but which, having been written by a bunch of amateur fuck-wits, provides absolute fucking garbage...?

Oh yes—it's Harry again.

Do you remember, in November 2009, that there was a leak from the University of East Anglia's Climate Research Unit (CRU)? Most of the media spent their time exposing the dirty tricks revealed in the emails between the "scientists" who are the main proponents of the Catastrophic Anthropogenic Climate Change (CACC) theory—including using collusion and blackmail to prevent dissident papers appearing in "reputable" journals.

But what was less widely reported was that, along with the emails, the computer "models" (again, advisedly) were released—alongside a very long commentary by an unfortunate programmer who was tasked with making sense of them.

The programmer was called Ian Harris, and his HARRY_READ_ME.txt file was, for those of us who like to delve into these things, an absolute treasure trove—revealing the incompetence of these so-called "scientists", and the utter invalidity of their much-vaunted "climate models".

And here we are again: with a government fucking our economy and freedoms, all on the basis of useless, garbage-spouting models.

Dear Boris (and every other government): for fuck's sake, stop giving any credence at all to these models. Models are not evidence and they are not science: even the most well-coded model would be nothing more than a theory—and, as we have seen with both COVID-19 and CACC, the people building said programmes are nowhere near being competent.

These so-called scientists are not: they are hobbyist coders (and bad ones at that). And where they attempt to sell their models as reliable, these people are frauds—and they should be prosecuted. If not, then a class-action lawsuit might find a large number of backers—especially if a case carries the prospect of personally bankrupting Neil Ferguson. Certainly, I would happily donate.

UPDATE: Tim Almond explains why "it's stochastic" is no excuse at all, and the Streetwise Professor is as incensed as your humble Devil...

Wednesday, May 06, 2020

Vaccine futility

As some of you may know, your humble Devil studied (in a desultory way) Microbiology at university, and has always had a special interest in human pathogens. So, today I would like to talk about why a "permanent" vaccine for the novel coronavirus is pie in the sky; and cannot, as Boris keeps maintaining, be a pre-condition of removing the lockdown—not, at least, on a permanent basis.

The first point to make is that the novel coronavirus (nCV) is a single-stranded RNA virus (more about that in a moment) and we do not have an effective vaccine against any coronavirus.

Nor do we have, as some have claimed, a permanent vaccine against 'flu: what happens in that case is that predictions are made about what 'flu variants are likely in that year, and then people are given a jab that aims to cover all of them. Sometimes this works (e.g. UK 'flu deaths in 2018/19 were circa 1,700); sometimes the predictions are wrong, or a new strain emerges, that is sufficiently different that the vaccine is largely ineffective, and deaths soar (e.g. UK 'flu deaths in 2014/15 were in excess of 28,300) [Source for both figures.]

To start with, let's sketch, at a fairly high level, why this should be.

High mutation rates


The first issue to address is why single-stranded RNA viruses mutate so quickly...
  • advanced cells (such as in humans) reproduce using DNA which, as we all know (right?), is a tightly wound, highly-stable, double-stranded helix;
  • when the cell reproduces, the DNA helix unwinds and cell machinery moves along the strand to duplicate it;
  • the second DNA strand is then used to check and validate that the original one has been duplicated correctly;
  • this validation step is why DNA-driven cells mutate incredibly rarely.
In a single-stranded RNA virus, not only is RNA less stable than DNA, there is no second strand—and thus no validation mechanism: this leads to far more transcription errors on replication, i.e. a far higher mutation rate.

Given that viruses replicate many millions of times, then one can see that mutations will happen pretty frequently. As we can already see in the new coronavirus...
Researchers in the US and UK have identified hundreds of mutations to the virus which causes the disease Covid-19.

But none has yet established what this will mean for virus spread in the population and for how effective a vaccine might be.
So, why would these mutations matter?

Antigens and antibodies


Again, very broadly speaking, human cells are not smooth: they are studded with structures that enables resources to be attached to, and absorbed into, them—vitamins, minerals, oxygen, enzymes, etc. Pathogens, including the coronavirus, attach onto one or more of these structures in order to pass into the cell.

In order to do this, viruses develop their own structures—in the case of coronaviruses, these are the S-spike structures that give them their name—which act as the "key" to let them into the cell. These "keys" are known as "antigens".

When combating pathogens, your body manufactures "antibodies": these bind to the pathogens antigens and they are highly specific. If the shape of the virus antigen changes in any significant way, then the existing antibodies will no longer work—and your body has to start all over again.

How vaccines work


A vaccine works by introducing a something that looks exactly like the virus, but does not do the same damage, into the body. The "shell" has the viral antigens, but the dangerous bit—the RNA—is damaged, disabled, removed or otherwise "attenuated". The body then recognises this fake virus as a foreign invader, reads its antigens, and builds antibodies that will attack anything that looks like it—all without you getting ill.

(Actually, whether or not you have a likelihood of getting ill or not rather depends on whether the virus uses negative-sense or positive-sense RNA—there is a higher likelihood of illness with a positive-sense RNA virus vaccine, such as nCV (influenza viruses are negative-sense)—but I am not going to get into that just now.)

However, if the viral antigens have mutated significantly enough that the existing antibodies do not recognise it, but little enough that the antigen can still grant it access to the cell, the vaccine will no longer work.

Summarising the problem


So, with sufficient changes in antigens, the vaccine-generated antibodies will not work, and those infected will suffer the ill-effects of the virus (many of which are actually caused by your body's reaction—particularly dangerous, and often fatal (particularly in COVID-19 patients), is a "cytokine storm").

Viruses with a high mutation rate (particularly single-stranded RNA viruses) tend to lead to a vast number of significant changes in antigens—rendering vaccines temporary at best, as with 'flu.

Coronavirus is a single-stranded RNA virus—so no vaccine is going to be permanent.

What now


As such, this new variant will be with us for a very long time—will we shut down for weeks every time that it comes back around? Well...

In my next post, I shall discuss various treatment pathways. But, please, do not think that "a vaccine" is going to be the way out of this mess—and if Boris and co start to make that a condition of lifting lockdown, call them out on it.

They are either dangerously ignorant, or lying. So, no change there then.

Neil "lockdown fucking" Ferguson finished on the face of her it

Neil Ferguson, the useless Imperial College charlatan whose ridiculous modelling—which predicted 500,000 deaths from COVID-19 in the UK—led to the lockdown, has resigned from the shadowy Scientific Advisory Group for Emergencies (SAGE) government advisory committee after inviting his married lover over for a good seeing-to on a couple of occasions.
Prof Neil Ferguson has quit as a government adviser on coronavirus after admitting an "error of judgement".

Prof Ferguson, whose advice to the prime minister led to the UK lockdown, said he regretted "undermining" the messages on social distancing.

It comes after the Daily Telegraph reported a woman had visited his home twice during lockdown.
Aaaaahahahahaha! Hahahahaha...
His modelling of the virus's transmission suggested 250,000 people could die without drastic action.
No, it didn't: his modelling estimated that 510,000 people would die without drastic action, and he doubled down on this figure very clearly.

Neil's past successes


Okay—enough hilarity. On a serious note, and as usual, it's one rule for Neil and his mates, and another for us. So, I am thoroughly glad that he has resigned from SAGE: the downside here is that this scare-mongering fuckwit is causing huge amounts of damage—as neatly outlined some time ago by Steerpike in The Spectator (£)...
In 2005, Ferguson said that up to 200 million people could be killed from bird flu. He told the Guardian that ‘around 40 million people died in 1918 Spanish flu outbreak… There are six times more people on the planet now so you could scale it up to around 200 million people probably.’ In the end, only 282 people died worldwide from the disease between 2003 and 2009.
Well, look, epidemiological modelling is quite difficult, and computer models were in their infancy. Neil will learn next time though, right?

In 2009, Ferguson and his Imperial team predicted that swine flu had a case fatality rate 0.3 per cent to 1.5 per cent. His most likely estimate was that the mortality rate was 0.4 per cent. A government estimate, based on Ferguson’s advice, said a ‘reasonable worst-case scenario’ was that the disease would lead to 65,000 UK deaths.

In the end swine flu killed 457 people in the UK and had a death rate of just 0.026 per cent in those infected.
Anyone can make a mistake though. I mean, despite the similarity of bird flu and swine flu, these were completely different circumstances and a chap can't be asked to get it right every time, eh?
In 2001 the Imperial team produced modelling on foot and mouth disease that suggested that animals in neighbouring farms should be culled, even if there was no evidence of infection. This influenced government policy and led to the total culling of more than six million cattle, sheep and pigs – with a cost to the UK economy estimated at £10 billion.

It has been claimed by experts such as Michael Thrusfield, professor of veterinary epidemiology at Edinburgh University, that Ferguson’s modelling on foot and mouth was ‘severely flawed’ and made a ‘serious error’ by ‘ignoring the species composition of farms,’ and the fact that the disease spread faster between different species.
Pffft. Look, Neil was an epidemiologist not a bloody farmer, for god's sake—how could he be expected to know that there are different species of cattle, or that the infection rates might be different.

Besides, it was really difficult for Neil to code that. His research student would have had kittens trying to make that work in his Python script.

Neil will get it right next time—just you see if he doesn't.
In 2002, Ferguson predicted that between 50 and 50,000 people would likely die from exposure to BSE (mad cow disease) in beef. He also predicted that number could rise to 150,000 if there was a sheep epidemic as well. In the UK, there have only been 177 deaths from BSE.
Oh. Right. He doesn't.

Ah, well, surely—with everything that he has learned, Neil will get it right this time...
Ferguson’s disease modelling for Covid-19 has been criticised by experts such as John Ioannidis, professor in disease prevention at Stanford University, who has said that: ‘The Imperial College study has been done by a highly competent team of modellers. However, some of the major assumptions and estimates that are built in the calculations seem to be substantially inflated.’
[...]
On 22 March, Ferguson said that Imperial College London’s model of the Covid-19 disease is based on undocumented, 13-year-old computer code, that was intended to be used for a feared influenza pandemic, rather than a coronavirus.
I mean... I guess that 510,000 does seem quite high. But who really knows...?
Has the Imperial team’s Covid-19 model been subject to outside scrutiny from other experts, and are the team questioning their own assumptions used?
Well that is a good question. As a matter of fact, some weeks after releasing their models, Imperial College London did, indeed, Open Source their COVID-19 modelling code on GitHub—which is a decent step towards transparency.

The trouble is, what they did not release were the configuration variables—the assumptions that they made when they ran the model. Which means that no one can properly replicate and validate their outcomes. Which seems to be par for the course in the scientific community these days.

So, what to do?

The Swedish model


Well, as we know, Sweden has not been following the same lockdown model as ever other country: they have introduced social distancing measures (along similar lines adopted by the UK government—before Neil came along with his Doomsday predictions) and their outcomes are... well... pretty good. Now, they are a sparsely populated country, for sure, but even in cities such as Stockholm, the death rate is comparatively low and herd immunity is predicted within a couple of weeks.

So, the University of Uppsala, in Sweden, came up with a good wheeze: into Neil Ferguson and team's model, they fed in variables that applied to Sweden—to see if the outcome matched reality. Can you guess what comes next...?
The Uppsala team’s presentation appears to closely follow the ICL approach. They presented a projection for an “unmitigated” response (also known as the “do nothing” scenario in the ICL paper), then modeled the predicted effects of a variety of policy interventions. These included staying the course on the government’s alternative approach of remaining open with milder social distancing guidelines, as well as implementing varying degrees of a lockdown.
So far, so good.
The model stressed its own urgency as well. Sweden would have to adopt a lockdown policy similar to the rest of Europe immediately if it wished to avert catastrophe. As the authors explained, under “conservative” estimates using their model “the current Swedish public-health strategy will result in a peak intensive-care load in May that exceeds pre-pandemic capacity by over 40-fold, with a median mortality of 96,000 (95% CI 52,000 to 183,000)” being realized by the end of June.

Their proposed mitigation scenarios, which followed lockdown strategies similar to those recommended in the ICL paper and adopted elsewhere in Europe, were “predicted to reduce mortality by approximately three-fold” while also averting a catastrophic failure of the Swedish healthcare system.
So, according to the modelling, Sweden should also have locked down in order to "avert catastrophe"—what could be clearer?
The Swedish model laid out its predicted death and hospitalization rates for competing policy scenarios in a series of graphs. According to their projections [...], the current Swedish government’s response – if permitted to continue – would pass 40,000 deaths shortly after May 1, 2020 and continue to rise to almost 100,000 deaths by June.
Oh my god—the poor Swedes! Quick, quick, lock down every bloody thing and... Wait, what?
So how is the model’s projection performing? Sweden’s government stayed the course with its milder mitigation strategy. As of April 29th, Sweden’s death toll from COVID-19 stands at 2,462, and its hospitals are nowhere near the projected collapse.
Oh. Right.

So, Neil and co's model over-projects the terrible consequences, and has an in-built bias towards a particular course of political action? Gosh.

How incredibly surprising.

(For a special gold star, can we think of any other poorly documented, immensely flawed computer models that behave in a similar way, children...?)

Let's be fair


On the other hand, Neil and his cronies did predict that a full-on lockdown might reduce deaths to around 20,000; this is, in the UK, proving to be on the low side (with COVID-19 deaths standing at 29,427, at time of publication)—although there are complications in reporting, which I shall discuss another time.

But, was the 510,000 figure ever credible? Well... Your humble Devil did call this crisis wrong, thinking that it would blow over: however, given the profile of the vast majority of deaths, I think that half a million plus deaths remains a gross over-estimation.

A summary of Neil's career


I think that it is fair to say that Neil Ferguson's most high profile epidemiological models have been failures—and hugely expensive failures at that.

Or, at least, hugely expensive for the taxpayer—no doubt incredibly lucrative for Neil and his buddies at Imperial College London. It is certainly true that, despite his very public fuck-ups, Neil remains employed.

And whilst it is amusing to see any arsehole brought down by personal malefactions—especially one so hypocritical and hubristic as this—it is hugely unsatisfying to see Neil resign for opportunistic personal fucking rather than being sacked, in disgrace, for his many eye-wateringly expensive professional fuck-ups.

There is, of course, still time.

The BBC on Ferguson


The BBC's summary of Neil Ferguson's career (or "Analysis" as it is hilariously entitled) is written by "health and science correspondent", James Gallagher—who, unusually for a BBC science journalist, actually has a science degree (biology).

I reproduce it in full, below.
Prof Neil Ferguson is one of the world's most influential disease modellers.

He is director of the MRC Centre for Global Infectious Disease Analysis.

The centre's mathematical predictions advise governments and the World Health Organization on outbreaks from Ebola in West Africa to the current pandemic.
It was that group's work, in early January, that alerted the world to the threat of coronavirus.

It showed hundreds if not thousands of people were likely to have been infected in Wuhan, at a time when Chinese officials said there were only a few dozen cases.

But he shot to public attention as "Professor Lockdown".

In mid-March, the maths showed the UK needed to change course or a quarter of a million people would die in a "catastrophic epidemic".

Those calculations helped transform government policy and all lives.
I think that you will agree that this is most certainly not "analysis"—and nor is it in any way impartial.

Does anyone else reckon that James Gallagher and Neil Ferguson are good friends...?

DK's final word


Ferguson is a proven failure—he certainly does not deserve the encomium delivered by Gallagher.

The eventual outcome of this pandemic is unknown; plus, of course, it is difficult to "prove" a counter-factual. Nonetheless, the Swedish experiment seems to suggest that, once again, the UK government has been persuaded into taking hugely expensive and illiberal measures based on wildly pessimistic models supplied by a man who has a history of producing wildly pessimistic models.

The decision to believe Ferguson, of course, must lie with the government: however, I believe that said government should release the minutes of all meetings concerning these models, and whether there were dissenting voices—perhaps from those who knew of Ferguson's past fuck-ups. If there were no dissenting voices, then we must ask "why not?"

In the meantime, Ferguson sexual peccadilloes may have tarnished his personal probity—but his professional reputation remains inexplicably intact.

One can only wonder as to why.

Thursday, April 02, 2020

Public Health England has blood on its hands

As your humble Devil has recently opined, the WHO is not fit or purpose—its original mandate of public health having been perverted by single-issue hucksters and authoritarian killjoys.

The only reason that the same cannot be said of Public Health England (PHE) is that—unlike the WHO, which did good work once—this organisation has never been anything other than a pointless waste of time and money, stuffed to the gills with more than 5,000 charlatans, bullies, corrupt academics, and fake charity apparatchiks.

Formed in 2013, under Dishface Cameron's coalition, PHE has the mission is "to protect and improve the nation’s health and to address inequalities". The latter part of this mission statement is presumably justified by frauds such as Wilkinson and Pickett, who attempted to show that inequalities cause health problems in their Spirit Level treatise—an entire book full of lies that was comprehensively debunked by Chris Snowdon in his Spirit Level Delusion (disclosure: your humble Devil designed the cover for that edition).

As for improving the nation's health, there is little to indicate that the £4 billion that PHE spends each year has done much towards achieving this target.

Where the organisation has fallen down extremely badly is... well... just look around. The coronavirus pandemic has shown PHE to have been caught with its pants down—and as the infection has developed, the stupidity of its denizens is beginning to look a lot like malice.

It seems superfluous to detail every single fuck-up that has led us to this position, and in which the supposed guardians of the nation's health has failed—so I will concentrate, instead, on the vexed issue of testing.

Whether or not testing alone is of use in stopping the virus is something that can be left to the epidemiologists—and most seem to agree that testing for coronavirus is of paramount importance. If nothing else, being able to gather data about the true spread of the virus, how many people might already have had it, and how many people are likely to become extremely ill from COVID-19, is vital in assessing how long this lock-down should go on.

Because, as others have pointed out, declines in GDP also kill people—through a variety of well-established mechanisms, such as suicides (especially of business-people who are seeing their life's work wiped out), cessation of treatments for other health conditions (such as chemotherapy) or non-treatment of others, or poverty. And my god, but we are going to see some colossal declines in GDP—and, possibly, millions of businesses bankrupted (rising ever more the longer the lock-down goes on).

So, the exerts—both economists and epidemiologists—tend to think that testing is pretty important. So, how has PHE been handling that then...?

In a word, "shit".

The new "Testing Times" report from the Adam Smith Institute's Matthew Lesh has established that PHE has right royally fucked it up by refusing to involve other organisations—seemingly through ridiculous intransigence and incredible arrogance.

Matt Ridley sums up this farce in The Spectator today:
The contrast with the United States is especially striking. America was found badly wanting at the start of the epidemic when the federal Centers for Disease Control insisted on controlling the process of testing people for the virus. It 'sought to monopolise testing, discouraged the private sector developing its own tests and misled state and local authorities about efficacy of its tests', writes Lesh. After heavy criticism, it reversed course, decentralised the system and rapidly expanded testing.

Germany and South Korea began farming out the work of testing samples to contractors from the very start. Britain did not. It initially sent all samples to one laboratory, at Colindale, in north west London. Public Health England also 'chose to develop and encourage the use of its own diagnostic tools, rather than seeking the development of a range of private sector tools and providing fast-track approval', Lesh finds. On 12 February, it began to use 12 other laboratories, but still only with its own tests.

When the number of people showing symptoms shot up in the second week of March, rather than outsource the testing, the NHS simply gave up testing all but patients in hospital. As if to reinforce the centralisation strategy, the government then announced the construction of a huge new testing facility in Milton Keynes, which may work well eventually but to date has been accumulating testing devices donated by universities some of which are sitting idle. The centralisation urge runs deep in this organisation.

By all accounts government ministers were calling for more involvement of the private sector from the start but their orders were being frustrated somewhere inside the bureaucracy of the NHS and Public Health England. The excuse was that the reliability of the tests had to be maintained at a high level, or else false positives and false negatives would cause confusion and danger. So even when other laboratories were eventually allowed to do tests, any 'presumptive positives' had to be sent to Colindale for confirmation right up till 28 March. The United States had suspended a similar policy on 14 March.

[...]

Here, private-sector providers were banging on the door of the NHS throughout, offering to do testing.

[...]

Yet centralisation is plainly a big part of the problem. Lesh finds that 'The UK’s Covid-19 testing has been dangerously slow, excessively bureaucratic and hostile to outsiders and innovation. There appears to be an innate distrust of outsiders. PHE has actively discouraged use of private sector testing. Even within the system, the process for testing and validation is very centralised.'
If, as many seem to, you believe that the lack of testing is costing lives—whether it is in NHS workers who are being sent to the front-line with little or no information, or those poor souls facing the ruin of their businesses, or those cancer sufferers now refused their therapies—then it is very clear that Public Health England has blood on its hands.

Despite spending billions of pounds of our money every year, the people at PHE have failed in their primary mission—"to protect and improve the nation’s health". When all this is over—or sooner, if possible—there needs to be a reckoning.

I think that it is fair to say that Public Health England has failed, comprehensively and catastrophically, at every point. When it comes to a real public health crisis—as opposed to bullying the population based on entirely baseless and fictional targets—PHE has demonstrated that, despite spending £4 billion of our money every year, it is entirely unfit for purpose.

If anything good can come out of this crisis, then it should be a very close examination of the purpose of our state agencies, and their performance against that purpose. PHE has failed on all fronts.

PHE's leadership (at least) must be sacked for gross misconduct, with the loss of all pension privileges: those at the very top should be prosecuted for culpable manslaughter. And no one who works for that organisation must ever be allowed to suck on the taxpayer teat ever again—there must be no "sideways" promotions for these useless bastards.

PHE should, ideally, be abolished. There is, alas, little hope of that but, if nothing else, its mission must be re-drafted: PHE must be focused on real public health issues—life- and economy-threatening pathogens such as COVID-19, and whatever comes next.

And PHE's record of failure this time around should be publicly displayed as a terrible cautionary tale of what happens when bureaucracies forget what their purpose is supposed to be. Or, of course, of how terrible bureaucracies are for getting things done effectively.

If there is a silver lining to this disaster, then re-thinking why these unaccountable state QUANGOs are spending so much of our money to so little effect must be a positive corollary.

Alternatively, we should burn it to the ground, shoot the staff, and sow salt into the remains.

Whichever—I'm easy.

WHO: burn it to the ground

In this critical pandemic, one would naturally look to the various public health organisations to understand how to react. Unfortunately, those most pertinent to your humble Devil's whereabouts—the World Health Organisation (WHO) and Public Health England (PHE)—have signally failed to step up to the plate.

As the lock-down—and whole-scale destruction of the economy—continues in the UK, some media outlets and think-tanks have been examining just why these organisations' responses have been so lack-lustre. And the reports are shocking—revealing not just, as one would expect from state bureaucracies, a culture of stupidity and uselessness, but very strong suggestions of corruption and mendacity that are still costing lives.

In the case of the WHO, it seems that a deference to Chinese sensitivities meant that Taiwan's warning—delivered at the end of December—that human-to-human transmission of the novel coronavirus (nCV) was not passed on to other countries.
Health officials in Taipei said they alerted the WHO at the end of December about the risk of human-to-human transmission of the new virus but said its concerns were not passed on to other countries.

Taiwan is excluded from the WHO because China, which claims it as part of its territory, demands that third countries and international bodies do not treat it in any way that resembles how independent states are treated.
Elsewhere, the WHO has been accused of being too deferential to China in its response to the virus, and a senior WHO official hung up when asked about Taiwan's highly successful response to the outbreak.

As your humble Devil has been saying for some years, the WHO is not the same organisation that wiped out smallpox—that smallpox remains so famous as the only major disease that humanity has wiped out would be testament enough to that statement. Indeed, wiping out diseases is actually quite hard work, so perhaps we should not be surprised that this organisation has, instead, turned its attention to reducing "non-communicable diseases"—also known as "bullying people about their lifestyles".

That the WHO has been allowed to pervert its mission so entirely that it sees rolling back the cause of liberty as its raison d'être would be bad enough: but its entirely inadequate response to a real public health issue only confirms that this organisation needs to be entirely destroyed. Lest we forget, in January, as the coronavirus was swiftly spreading around the world, the WHO was still Tweeting about the evils of e-cigarettes.

The organisation is not fit to do the job for which it was formed: as with all bureaucracies, its only real purpose now is to perpetuate itself. It must be destroyed, its staff sacked and publicly ridiculed (accompanied by photos), and the ruins sowed with salt.

And as for Public Health England... Well, your humble Devil will opine about that organisation presently.

Wednesday, March 25, 2020

Steve Baker: still decent, still libertarian

When your humble Devil adopted Steve Baker MP as this blog’s mascot in 2010, Steve was somewhat concerned—and asked a number of free market people whether this dubious honour should be politely declined.

Apparently the answers mollified him, as he not only did not ask for his title to be removed, but also bought me dinner a couple of times in the House of Commons—when we discussed, amongst other things, matters libertarian (and Libertarian Party).

Over the course of the last decade, Steve has repaid your humble Devil’s faith in him many times—especially as concerns Brexit, and in the defence of liberty.

Via Guido, here is Steve, close to tears, as he implores the government to sunset the Coronavirus Act after one year rather than two.



The text of his speech is below:
I stand first with my hon. Friend the Member for Isle of Wight (Bob Seely). We cannot neglect his constituents on the Island. I fear that this issue has gone on for far too long, and I want to say sorry to ​him that we did not weigh in behind him sooner. This issue has just got to be dealt with, and I know that my right hon. Friend the Minister knows that.

Secondly, I would like to pay tribute to hon. Member for Bradford West (Naz Shah). She has done an absolutely fantastic job in the last 24 hours. It has been a real privilege to work with her to secure what I think is a fantastic result. At a time like this, matters of the hereafter are close to everybody’s thoughts. They sometimes say that there are no atheists in a foxhole. I certainly would not want to stand by and see my constituents cremated against their wishes, and nor, indeed, would I want to see people buried against their wishes. I really want to congratulate her; she has done a fantastic job, and she has done it in a wonderful cross-party spirit, which has done a lot to reinvigorate my faith in this place and in what we can achieve together when we put our constituents first. Well done to her.

I will pay particular attention to amendments 1 and 6 and Government new clause 19, which relate to the expiry of these powers. When I got into politics, it was with the purpose of enlarging liberty under parliamentary democracy and the rule of law. When I look at this Pandora’s box of enlargement, discretion and extensions of power, I can only say what a dreadful, dreadful thing it is to have had to sit here in silence and nod it through because it is the right thing to do.

My goodness, between this and the Prime Minister’s announcement tonight, what have we ushered in? I am not a good enough historian to put into context the scale of the infringement of our liberties that has been implemented today through the Prime Minister’s announcement and this enormously complicated Bill, which we are enacting with only two hours to think about amendments.

I could speak for the time I have available several times over just on the provisions relating to the retention of DNA, which we addressed in the Protection of Freedoms Act 2012. [Interruption] I see from the expression on the face of the Paymaster General, my right hon. Friend the Member for Portsmouth North (Penny Mordaunt), that she understands the anguish—she probably knows it better than any of us—that we are all going through in passing this Bill.

Let me be the first to say that tonight, through this Bill, we are implementing at least a dystopian society. Some will call it totalitarian, which is not quite fair, but it is at least dystopian. The Bill implements a command society under the imperative of saving hundreds of thousands of lives and millions of jobs, and it is worth doing.

By God, I hope the Prime Minister has a clear conscience tonight and sleeps with a good heart, because he deserves to do so. Libertarian though I may be, this is the right thing to do but, my goodness, we ought not to allow this situation to endure one moment longer than is absolutely necessary to save lives and preserve jobs.

Although I welcome new clause 19 to give us a six-month review, I urge upon my hon. and right hon. Friends and the Prime Minister the sunsetting of this Act, as it will no doubt become, at one year, because there is time to bring forward further primary legislation. If, come the late autumn, it is clear that this epidemic, this pandemic, continues—God help us if that is true, because I fear for the economy and the currency—there ​certainly will be time to bring forward further primary legislation and to properly scrutinise provisions to carry forward this enormous range of powers.

Every time I dip into the Bill, I find some objectionable power. There is not enough time to scrutinise the Bill, but I can glance at it—I am doing it now—and see objectionable powers. There would be time to have several days of scrutiny on a proper piece of legislation easily in time for March or April 2021.

I implore my right hon. Friend, for goodness’ sake, let us not allow this dystopia to endure one moment longer than is strictly necessary.
Once this farce is over with, we must all lobby our MPs in order to strike down this terrible legislation—it must not be allowed to stand for even two years.

In the meantime, it seems that Steve Baker MP must remain this blog’s mascot for the foreseeable future.

Sorry, Steve.

UPDATE: Steve Baker’s comment on this Bill can be found on his blog.

Tuesday, March 24, 2020

The problem with the NHS is not enough management

So, if you read the title of this post alone (and read any media, or talk to any NHS workers), then you are probably going to get annoyed and slag me off—but you are wrong. Let me explain why.

Two incentives

In any ward team in the NHS, there are two separate structures—there are those who work for the Trust itself (who I shall call “corporate”), and who worry about capacity and payments and bed occupancy; and there are the “clinical” staff (doctors, nurses, etc.).

In any NHS Trust, these people are working at almost entirely cross-purposes: the clinical staff are only incentivised as to the best treatment for their patients (and thus are inclined to be conservative) and the corporate staff who need to ensure proper throughput of beds, conservation of costs, etc.

The corporate line of command is largely through Ward Clerks, Matrons, and similar.

As far as the clinical line of command goes, the Consultant is in charge (followed by Registrars, followed by Senior House Officers, followed by F2s, F1s, etc.). It cannot be emphasised enough that their incentives—financial or otherwise—are not in any way aligned with those of the Trust who pays them.

The above is mostly true, except where poor care might lead to prosecutions, or similar, where the Trust is expected to bear all of the costs (not always true—but mostly).

For the reasons outlined above, these two entities are, almost all the time, at loggerheads.

Perverse incentives

For many nurses (and some doctors), the only way to progress over a career is to go into what is called, in the NHS, “management”. What this means is that previously clinical staff are now supposed to be aligned to “corporate” interests. This is perverse for four main reasons:

  1. you remove highly skilled clinical staff from what they do best, i.e. treating patients;
  2. you introduce a “clinical” mindset into “corporate” incentives: this might work, except that you are not screening people for suitability—only career progression;
  3. you have no guarantee that these people are able to manage a team;
  4. in any case, as far as management goes, they can be over-ruled by Consultants. So, they have incentive and responsibility—but without power.

No effective management system can work like this.

What about all the managers?

So, what about all these managers that we hear about in the NHS—aren’t we paying them all to do stuff?

Yes, of course we are. The trouble is that they see themselves as outside of the clinical framework—and often they are required to be.

  1. Strategic Managers—these are the people who worry about how to pay the bills, to lobby the government and NHS-D, NHS-X and more. Their job is to run the “company” and to push it forward. It is not their job to manage wards, or the sick—it is to ensure the viability of the business (and an NHS Trust is a business);
  2. Comms Managers—these people have a number of roles, but the biggest is in reputation management. They also have a huge roles in attracting and retaining staff (we all know that the NHS is short of qualified clinical staff, right?);
  3. IG / HR / IT: widely despised amongst clinical staff, these people nevertheless have a job to do. One can argue that they have been too hide-bound, too conservative—but, with each fresh disaster, this is changing.

So, what is the solution?

It is quite simple: you need managers on the Wards who are actual managers: they are paid to make decisions, and they can triangulate between a “corporate” Ward Clerk and a “clinical” need.

This means—and I cannot stress this enough—that this manager can over-rule a Consultant when necessary.

The role of a Consultant is going to have to change: they can no longer be viewed as “gods” who are utterly indispensable. They must be held responsible not just for the care they ostensibly provide, but also to the Trust for which they work.

Further, these Ward Managers cannot be far-away strategic Trust advisors—they must be on wards, making these decisions, 24/7.

Wait—but they aren't medically qualified

They might be.

But I work as a manager in a small software firm: I don’t know the precise coding implications of doing this or that—but I know how to ask the right questions, so that I understand the consequences of this or that. I can look at timescales, stair-casing impacts, architecture and Board strategy, etc.

In doing so, I am able to weigh up all of the options without specialist knowledge (although a vague knowledge helps in detecting bullshit, obviously). The point being that, given the information from both “clinical” and “corporate” the Ward Manager is able to make a decision—and, yes, be held responsible for that decision—quickly and with a reasonable amount of judgement.

Those who take their management role seriously in private companies (and there are many who do not) are able to divorce themselves from previous associations: in this case, for instance, were a nurse to be promoted it would be because they were a good manager—not that this was the only career advancement open to them.

So, what does this job look like?

These people need to be on the ward all day, every day. That means staffing night shifts too.

These people are directly responsible to the Head of Clinical Management at Board Level.

These people are diplomatic, firm and (I know this sounds trite) good people managers, and also understand the business drivers of the Trust. There are thousands of people that I have met who could do this job well—although they are eclipsed by the tens of thousands who would (and, in some cases, are) do it badly.

How would you test it?

I have come to the conclusion, over a number of years working with NHS organisations, that my dream job would be the CEO of a failing NHS Trust. And I would enact this there (as well as a bunch of other reforms).

Maybe it won’t work—but I think that it will.

What are the risks of this model?

Consultants are going to have their nose severely put out of joint. The BMA will rage about it—but, given that the BMA is almost entirely responsible for everything that is wrong with the UK Health Service, I would be happy to fight them all the way.

I would lobby the government to delist the BMA as a union, and provide solid evidence to show that the organisation is entirely opposed to an efficient health service in the UK. This is not hard to prove.

I would also remove the pointless exams that professions undertake to show that they are “capable”—as with the legal profession, these are trades union exams imposed to keep themselves relevant, and bear no real-world relation to capability or knowledge.

Outcomes

The anticipated outcomes would be:

  1. more clinical staff in clinically relevant positions—this means providing a suitable career advancement path outside of management;
  2. recruitment of managers—misfits and weirdos may apply;
  3. better outcomes for patients—long hospitals stays are deeply unhealthy, and lead to massive complications;
  4. a more secure financial position for the Trust—and thus for the NHS in general;
  5. this means more money to invest in efficiencies such as electronic patient records (EPR)—which will mean an end to sloppy practices and illegible hand-writing.

Summary

Finally, I cannot explain to you just how poorly the NHS is run. Money is just thrown away, and there is no prioritisation in any meaningful sense. Comms Teams and clinicians have no contact, and both of them hate the IT Team.

The whole thing is dysfunctional in the extreme: the more one works with the NHS, the less one becomes inclined to see any more money thrown at it.

This essay is a short stab at addressing just one problem: many more need to be solved.


Wednesday, January 29, 2020

O mi god brexit kills expats lol

Surely this is yet another of the evils of Brexit?
British expatriates who move to Portugal could lose their tax free status under new plans being brought in by the left-wing government in Lisbon.

The ruling Socialist Party introduced an amendment to this year's budget which will levy a 10pc tax on the foreign revenue of British pensioners and other foreigners who move to Portugal.
Or perhaps it's just the work of those dastardly left-wingers and Communists who have been elected by the Portuguese...?
In the wake of the 2008 financial crisis, Lisbon introduced a 10-year tax exemption for European nationals on condition they lived in Portugal for six months a year.

To enjoy this tax perk, they had to qualify for non-habitual residence (NHR) status, under which a person cannot have lived in Portugal for the previous five tax years. The scheme allowed expats to pay no tax for 10 years on foreign income. For Britons this could be pension income, dividends, rental income and non-Portuguese employment income.

The relief was designed to try to bring badly needed foreign investment into the ailing Portuguese economy.
Oh, no: it was just a temporary measure to stimulate investment at a particularly stressed economic time.

The breathless headline of "British pensioners in Portugal to lose tax-free status" does, though, illustrate quite nicely how difficult it is for governments to remove goodies handed out to people—even when those goodies were always intended to be temporary...

The very model of a modern scientific man

Your humble Devil was thoroughly amused by Neil Ferguson's fall from grace, and is very pleased to have found the time to outline Fergus...