Matt Hancock on the NHS and my thoughts.

On the 27th of February, Matt Hancock, addressed the Nuffield Trust Annual Summit about the NHS.  He made some comments in his lengthy speech that need to be clarified.

The whole country is concerned about the developing situation with coronavirus – covid-19. We are doing everything reasonably possible to keep the public safe.

I want to start by praising the exemplary response of my officials, Public Health England, the whole NHS and the wider health system. Earlier the Chief Medical Officer Chris Whitty set out our plan to contain, delay, research and mitigate the virus.

That plan will be driven by the science and guided by the expert advice of Professor Whitty and others. Tackling this virus is imperative and it’s taking up the overwhelming proportion of my time. While we grapple with the virus, I am determined that we don’t take our eye off the long-term challenges that we also need to rise to, and the long-time changes that we need to make to our healthcare system to make it the best it can be. 

Delivering our manifesto commitments including 50,000 more nurses and 40 new hospitals. 

But you will be recruiting just 31500 nurses. https://www.independent.co.uk/news/uk/politics/tory-manifesto-boris-johnson-nhs-nurse-police-general-election-conservatives-a9215811.html

And are you really going to build 40 new hospitals? https://www.lbc.co.uk/radio/presenters/andrew-castle/matt-hancock-40-hospitals-pps/

Addressing the priorities of people, infrastructure, technology and prevention.

So today at this conference I want to ask this big, long-term question and formally set the health system a new goal. The question is, how do we ensure that in today’s world there is always public confidence in the NHS? In a speech to the Royal College of Nursing in 1948 Nye Bevan gave a famously gloomy assessment:

He said: “we shall never have all we need”.

“Expectation will always exceed capacity”.

The service “must always appear to be inadequate”.

Now I am generally sceptical of those who say ‘this time is different’ but today I want to argue exactly that. My argument – and I appreciate this is a dangerous thing for a Health Secretary to say to the Nuffield conference – is that Bevan was wrong.

The service does not always have to ‘appear to be inadequate’, either for patients or staff. This time can be different.

And it should be. But the performance of the NHS has worsened since 2010 when Labour was in charge.  Look at how many more patients are having to wait in A&E for beds. https://www.bbc.co.uk/news/health-51565492

And the reason is that today’s technology – unlike previous technological advances – allow us to do more in healthcare at lower cost.

Now I don’t think that’s ever been true before in the history of the NHS.

There have been amazing advances like heart transplants and chemotherapy that have allowed us, at greater cost, to save more lives. Those are good technologies. But the power of modern technology is that it allows us to improve outcomes and cut costs. Radiology in the cloud is cheaper and faster than a system based on couriers and CD-ROMs for example. 

It would be great if we had enough radiographers https://www.theguardian.com/education/2019/dec/10/next-nhs-staff-shortages-will-include-radiographers-as-courses-close?CMP=Share_iOSApp_Other

And while technology on its own solves little, technology that clinicians want to use because it meets their real-world needs, designed with their input, done with them and not to them – this has game-changing potential. And we know because we can see it right across every part of the economy and we can see it in parts of the NHS.

Get it right and by the end of the decade we can have an NHS that functions as a platform rather than a set of loosely aligned, disconnected incommunicative silos, an NHS focused on preventing sickness, not just treating it, enhancing life, not just prolonging it. Where staff do more of what they came into medicine to do – caring, treating, healing the human things that a computer could never replace – because we’ve removed or improved the grind of routine process. And to make that happen, we need to change the way we think about how change happens in the NHS.

Now policymakers love the idea – and I can tell you it’s tempting – that change is something to do with top-down reorganisations and big bang structural reforms.

It’s why the last couple of decades are littered with failed attempts to ‘transform’ the NHS by structural reform from on high.

Remember that pledge before 2010 that there would be no more top down reorganisation of the NHS? Followed by the biggest reorganisation it has had after the Conservatives were elected? Forgive me if I do not believe you again! https://www.hsj.co.uk/5029088.article

But guess what? It’s not all about us policymakers! The answer to better healthcare lies less in complex reforms cooked up by the centre. We’ve tested that idea to destruction.

It lies in millions of incremental improvements, carried out at every level of the service, every day by people who feel and are empowered to make things better in pursuit of a common goal. The small tweak to a process that improves patient flow.

The trust that saves hundreds of hours of clinical time with access to real-time test results for example.

The streaming that manages record demand on our A&Es.

Actually decent funding and staffing of both the ambulance service, primary care, A&E and social services (to get people out of hospital) would solve that. https://www.birminghammail.co.uk/news/midlands-news/patients-left-waiting-up-more-16726085

These are the things that transform the NHS. It doesn’t happen on its own. It requires strong accountability. It requires the right data so the system can constantly learn from itself what works.

It requires the resources: including the record £33.9 billion funding increase now enshrined in law. And it requires trust. Trust in clinicians to make those improvements. Trust in local systems to serve their population as a whole. Trust in patients to play their part in their own health.

That’s how change happens in big organisations like the NHS.

Like your own local hospital? Where the action taken on allegations of a coverup over substandard care is to identify the whistleblower? https://www.theguardian.com/society/2020/jan/24/west-suffolk-hospital-faces-fresh-questions-over-whistleblower-tipoffs?CMP=Share_iOSApp_Other

But this method of marginal improvements requires people to also have a common mission. My case is that we must free people up to innovate, and in all the large organisations where freeing people to innovate has worked it’s because they’ve had a common goal.

Two goals for the NHS

So today, I want to set 2 goals for our healthcare system – not just the frontline NHS but the system in its broadest possible sense. The department, the central bodies, social care and the ecosystem that surrounds them.

One is a clinical goal, the other a goal of ‘user experience’.

Both are equally important. Each reinforces the other.

The ultimate clinical goal is to increase healthy life expectancy in this country.

As a nation, we have set the goal of 5 more years of healthy life expectancy by 2035.

Not just adding years to life but life to years.

A bit rich to say this considering how austerity has had a worse effect on life expectancy in the than in other developed nations. Even more so for those who are less well off. https://www.independent.co.uk/news/health/austerity-death-rate-life-expectancy-flu-uk-a9350346.html

But this clinical goal is not enough on its own.

Everyone in the NHS goes to work to serve patients, not just to treat them.

Indeed, the whole NHS serves our country just by existing, by giving peace of mind to everyone, even if you very rarely use it.

So the second goal I want to set is to increase public confidence in the NHS.

Confidence that the NHS will always be there for us. That the NHS will look after us and care for us with dignity and respect. That it will treat me as a person with a history and a future, not just a series of unconnected clinical episodes.

Now public confidence is not the same thing as public support – important as that is – or even public satisfaction with the quality of an individual treatment.

How you’re treated at reception, whether staff have pride and the hospital is tidy, whether someone explains to you what’s happening and keeps you properly updated. These things might not matter from a strictly clinical point of view, but they should matter to an organisation paid for entirely by the public and which exists to serve the public. I want to draw a parallel to what’s happening on coronavirus right now. This approach is working. It is an explicit goal not just to tackle the disease but to maintain public confidence.

We should take this same attitude to health services in normal times too.

In the second quarter of 2019 the NHS received 50,000 written complaints on various subjects. What was the one subject that accounted for the largest proportion of complaints?

Communication.

So I’m setting the NHS the challenge that it should be as good at process and admin as it is at medicine, that if you’ve got a chronic condition you shouldn’t have to carry a ring-binder of notes from one appointment to the next because your provider can’t access your full medical record. That we shouldn’t be asking you to make a stressful journey into hospital when you could get the same result at home using modern digital tools. That when you’re notified of an appointment it should never arrive after the appointment was meant to take place. 

So we are to ignore how patients are waiting even longer for treatment, but instead are to focus on them getting an appointment letter before the appointment that they have to wait longer for than they did in 2010?  https://www.pryers.co.uk/nhs-waiting-times-hit-all-time-high/

That is one of the most frustrating things and it happens right now. The National Health Service must be just that. The National. The Health. And the Service. Not just a hospital system but a service for the nation’s health. So I want to take each of these in turn, because they are all important.

National

Let me take these 3 in turn: national first. Loving the NHS is a part of our national identity. We love it because it’s always been there for us, unconditionally, through some of the best moments in life and through some of the worst. This is what maintains the public support for the NHS. As the Prime Minister puts it, it’s like the whole country figuratively gathering round your bedside when you fall sick, doing everything it can to make you well again. But that shared ideal is one of the few things about the NHS that is truly national. Because the NHS is not some centralised command-and-control state like Bismarckian Germany.

While you mention Germany, you are aware that they have a better healthcare system than us with more funding (per person) and more staff than the NHS? https://healthpowerhouse.com/media/EHCI-2018/EHCI-2018-report.pdf

And I can assure you as Health Secretary I know that. It’s more like the Holy Roman Empire: a story of fragmentation, duplication and high levels of regional variation.

There is no single national NHS back office for example. Local providers have their own teams and systems for every conceivable non-clinical activity, from booking appointments to registering patients to organising staff rotas to ordering medical supplies – with massive duplication of effort. Nor is there a national data architecture. I first discovered this through personal experience – like many people do. My sister had a very serious accident just before I became Health Secretary and a near-fatal brain injury. She received amazing, life-saving care at Southmead hospital in Bristol. She underwent 6 months of rehabilitation. And when she went back to her GP to get approval to reapply for her driving licence, despite having known her all her life, her GP had no idea – no record – no details at all.

Missing information from GP records? Who might be responsible for that? http://www.bbc.co.uk/news/uk-england-37874856

That is not a unique experience, it’s an everyday occurrence.And when I say national there’s another aspect to national we need to look at – let’s look at national health outcomes.We have a chequerboard of local variations.

Take healthy life expectancy. I think this is a very serious problem.

I agree. And it has worsened for the poorest women under the Conservatives.  https://www.bbc.co.uk/news/health-51619608

A person born in Wokingham can expect 72 years of healthy life. In Nottingham it’s 54 years. In Blackpool, 1 in 4 women smoke during pregnancy. In Westminster, it’s 1 in 50. So this is the first part of our project. In the 2020s we must make it our mission to put the ‘national’ back into the National Health Service. At the patient-facing end of the service that means levelling up access to healthcare. Ending postcode inequality so for instance your chance of seeing a GP doesn’t depend on where you live.

Just a reminder that the GP workforce lost hours thanks to the ‘improvements in GP retention and recruitment brought in by the Conservatives. https://www.gponline.com/fully-qualified-gp-workforce-down-277-past-year/article/1675333

Not just delivering the 50 million more GP appointments that we committed to in the manifesto but making sure they’re focused on where they’re needed most.

Being a national service means having consistent standards that all patients can expect. You want local variation where there’s variation in local conditions.

It will be a central task of the new Integrated Care Systems in every part of the country to take into account local conditions when improving the health of their populations. But we need less unwarranted variation in both commissioning and delivery of services.

Why should 3 cycles of IVF be allowed in some parts of the country while some parts offer none?

That is an interesting question when you know that the answer relates to funding of the NHS not keeping up with need. https://www.independent.co.uk/news/health/ivf-nhs-treatment-fertility-lists-wait-patients-lottery-budget-cuts-a8028116.html

A local part of the NHS deciding it’s OK not to offer IVF, with no accountability – it’s absurd and it’s unacceptable in a national service.It also means having a platform approach to the way we deliver some of things like the back office. Building once at the centre where it makes sense to do so, so suppliers and commissioning bodies don’t have to recreate the plumbing each time.

Look at NHS Login, our national ID assurance platform. It supports a growing ecosystem of new digital services, from GP appointment bookings to remote consultations to digital maternity services – all of which require you to prove who you are. We’re also looking at a consistent way to identify staff across the system.

But the most impactful and clinically useful platform we can create is a national data architecture for the NHS. It’s a massive opportunity: for patient experience, clinical excellence and the next generation of research. Fixing this is not, repeat not, about building a single, giant centrally owned patient database in the basement of NHS England. Instead it’s about creating an architecture so systems can talk to each other and so data can be safely accessed where it’s needed. We need the whole country to be covered by local shared care records. We need those shared care records to be able to speak to each other with common standards, we need clinicians to have the trust and confidence to use them. And I can announce that we’ve just published our new draft digital health technology standard. Designed to make it easier to commission great new digital health services, it requires developers to follow our standards on interoperability if they want us to buy their stuff.

There’s much more to come.

And today we’re kicking off engagement on our Tech Plan for health and care, setting out how technology will support delivery of the NHS Long Term Plan.

This includes establishing what good looks like for all forms of tech-enabled care, clarifying who pays for what, and what we need to do to drive these improvements.

I would urge you to all get involved, everybody, whether you’re interested in technology or not, because developing this plan should not be left to us at the centre – it’s too important for that. There will never be a big bang moment when we flip a switch and the problem is solved. Like all genuine improvement this is an incremental, iterative process. Done right, this approach must be entirely embedded in evidence. It’s about what works. And the evidence is abundant, it’s strong and it’s growing. Bringing technology in the NHS into the twenty-first century works. Modern use of data works. Ignoring that evidence is as much of an error as blind faith in technology. So I’m determined to drive this agenda because if we get the technology and the data right, we can do incredibly powerful things in health.

Which brings me to the second letter in NHS – H for health.

Health

According to the best evidence we have, only around a quarter of what leads to longer, healthier lives is the result of what happens in hospitals. The remainder is down to genetics, the environment and the lifestyle choices that we make.

You forget to mention austerity there. Why? https://www.theguardian.com/society/2020/feb/24/austerity-blamed-for-life-expectancy-stalling-for-first-time-in-century?CMP=Share_iOSApp_Other

As a healthcare system, we actually have strong track record on improving both the broader determinants of health – the inputs – and health outcomes. So smoking rates in Britain have halved in the last 35 years and we now have one of the lowest rates in Europe. We lead the world in managing long-term conditions like diabetes, with fewer than one in a thousand patients being admitted to hospital in a given year. Deaths from cardiovascular disease have halved since 1990, cancer survival is at an all-time high, male suicide is at a 31-year low.

Such improvements are important but we still lag behind too many other developed nations when it comes to cancer survival.  https://www.bbc.co.uk/news/health-49661516

Is that because the waits for cancer treatment in the NHS are the worst ever? https://www.theguardian.com/society/2019/jan/10/nhs-england-misses-multiple-targets-for-cancer-treatment?CMP=Share_iOSApp_Other

We also have some of the finest public health officials in the world and I’m very grateful for the work they’ve done on our response to covid-19.

But we can and must go further. For most of its 70 years, the NHS has been focused on curing a patient of a single illness, putting ever more funding into big acute hospitals. This has had an impressive impact on lifespan over the past 70 years.

Yet as it enters its eighth decade, as we’ve seen those increases in lifespan start to slow, it’s clear the NHS needs to focus more on health-span: the number of years a person can expect to live healthily and independently. Prediction and prevention are mission-critical for delivering on those 5 extra healthy years of life. This is partly about getting smarter in the way we use NHS resources. Things like dedicated alcohol care teams in hospitals with the highest rates of alcohol-related admission, or quit-smoking help targeted at CVD patients.

But your government has cut funding for services to help those with drug and alcohol addiction! https://www.theguardian.com/society/2020/feb/05/reduce-uk-drug-deaths-by-funding-treatment-services-experts-urge?CMP=Share_iOSApp_Other

Modernising the IT systems on which our national screening programmes are delivered, so they’re easy to use and no one gets left behind. Putting more resources into primary care and community care, and asking our army of pharmacists to do far more to keep people healthy. Or rolling out non-drug therapies through social prescribing, right across the country.

A lovely aspiration but not possible if you place underfunded undeliverable unrealistic demands on the NHS. https://www.nursinginpractice.com/article/PCN-draft-DES-nurse-feedback

But this approach is also about recognising that not all the answers are in the NHS.

That we need cross-government action on air pollution, properly insulated homes and urban design that supports cycling and walking. People have been talking about the need for more prevention since the 1950s. So again you’re entitled to ask: why is this time different? Firstly because we have more and better information than ever before. A lot of it is distributed outside the system, on Fitbits and smartphones and other internet-linked devices. We’re also creating increasing amounts of genomic data, including our project to sequence 5 million genomes. Having all that data matters because there are still big gaps in our knowledge about what works and for whom.

Take drug responsiveness.

A few years ago, Professors Eric Topol and Nicholas Schork put together a study showing the responsiveness – the intended clinical response – of the top 10 drugs by gross sales in the US. It shows that overall, 75 percent of patients receiving these drugs do not have the desired or expected benefit. This ranges from only 1 in 5 patients with schizophrenia deriving a benefit from the market leading schizophrenia drug, to only 1 in 16 patients with multiple sclerosis. This is known as the ‘number needed to treat’, which means the number of patients you need to treat to prevent one additional bad outcome. Until we can safely use all the data that we hold about individual patients, that number will remain stubbornly high.

Cancer is another example.

Major trials funded by the NIHR show that many people given surgery or radiotherapy for prostate cancer will do no better than those without treatment.

But we don’t know which people in advance. If we can marshal all the data about a patient, then we can treat each patient as an individual, finding the treatment that’s right for them. Bringing the ‘number needed to treat’ closer to one, saving the NHS and patients the cost and pain of unnecessary treatments.

So that’s the first big change we can harness.

The other big difference is that we now have the computing power and the artificial intelligence to do the marshalling. Already, AI can perform as well as human radiologists at detecting certain cancers. AI developed at MIT recently found a new antibiotic for tackling drug resistant microbes. This is why we’ve set up a £250 million AI Lab in the NHS to identify and scale the most promising technologies and crucially, to get the regulation right. 

By the end of the decade we need doctors to have all the relevant data about the patient in front of them, not just the patient’s full health record but genomic data, any self-generated data they want to volunteer, and data on similar cases. We need them to have the AI and other decision-support tools to process that data, and we need them to have the right training to understand it all. It can be done. It is being done in the most advanced parts of the NHS. We need to turn the NHS from a national hospital service to a health service. Making sure that we’re focused on the health of the patient.

Service

And that brings me to the third part of the NHS: ‘S’ is for service. I’ve drawn a deliberate distinction between health and service. Between clinical outcomes and public confidence. To help explain what I mean, I want to tell a story. I mentioned the problem of different care settings not being able to access vital patient records. At Barts in East London, they’ve solved that problem for chronic kidney patients.

It works like this. The renal unit at Barts have a data-sharing agreement with 160 local GP practices, allowing consultants to remotely view full GP records with patient consent. It means they can see a patient’s creatinine levels over time – a crucial indicator of kidney health – as well the medical history, co-morbidities, past hospitalisations and so on. Following review of the notes, the consultant records her advice on Barts’s system and the practice gets a notification. The small minority of patients who need further investigation then get triaged into traditional face-to-face clinics. The vast majority of patients don’t ever have to go to hospital. And they get reviewed much faster. Before the virtual kidney clinic started, the average time from referral to first outpatient appointment was 64 days. Now the time between referral and assessment is less than a week.

It’s too early to say if it’s improved clinical outcomes.

But that is not the point of the exercise. The point is to improve the service. Because if you’re in a nursing home with chronic kidney disease, then getting into central London to go to Barts can be a real ordeal. The virtual clinic improves patient access to the NHS, while removing the whole rigmarole of arranging transport, travelling in, worrying about tube delays, tracking down missing referral letters and sitting around in waiting rooms when you’re not very well. Not only did patients enthusiastically consent to their records being shared but like all the best service improvements, they were amazed that it wasn’t already happening.

There are loads of other areas where we can make the service better.

As I said, the medical advances in the NHS are amazing but the process advances are far too slow. Royal Mail should not be the default mode of communication between patients and providers. Patients should have access to their own medical records. We know it improves the quality of the data and where they spot a mistake, it can be lifesaving. University Hospital Southampton give their prostate patients real-time digital access to their PSA results as soon as they come out of the lab, unmediated by a physician. It’s incredibly popular, even among older men with less digital experience. And the reason is that people want to manage their own care.

And wherever possible, healthcare should come to you before you have to go to healthcare.

This is not as radical as it sounds.

And I know there are some people who scoff at this agenda. But let me give you one example that we now take as read. Thirty years ago you had to go to a doctor to get a pregnancy test. Now you take the test yourself before you go to the doctor. Of course you do! It’s not just about the technology. Our capital building programme is about ensuring the best possible service for patients, as well as clinical outcomes.

Because patients don’t only care about the clinical treatment. They care that the hospital looks smart. That it’s clean. That staff are friendly and well-motivated. That the food is good, and that they were told clearly what is going on. These are the things that matter to patients, and they need to matter to every single person who works in the service. For the NHS is a service or it is nothing. And we are at the service of our nation.

At Great Ormond Street they now note a child’s favourite food or football team to help busy staff make a connection with the child. A simple change that can make an incredibly stressful experience just a little bit easier.

So there you are.

The NHS. Our National. Health. Service.

To entrench and underline the central importance of that sense of service – that’s why I’m setting today the explicit goal of raising public confidence in the NHS.

This is a hugely ambitious and exciting agenda. Everyone here has a part to play.

It’s first and foremost about people: about how we get the most out of the people who make up the NHS – how we motivate, incentivise, support and train our people. I’m proud to see the staff survey results moving in the right direction.

It’s brilliant news that we’ve increased the number of nurses in the NHS by over 8,000 in the last year alone.

Shouldn’t that number be 18500 or are you going to massage those figures later? https://www.mirror.co.uk/news/politics/boris-johnsons-50000-new-nurses-20950772

And with the People Plan we will set out yet more how we can support every single person in the NHS to reach their potential. It’s about infrastructure, fixing the roofs and getting the modern buildings we need to deliver modern services closer to home. It’s about prevention of ill health to reduce pressures on the system. And yes it’s about technology, because there are historic problems that we can now fix by bringing the technology of the NHS into the twenty-first century. We all know that demand and expectations are rising. We can’t afford to stand still. To reshape our health service we must harness the resources that the modern world can offer.

And deliver a National. Health. Service. Of which we can be proud.

Holes

I got a new Arsenal rucksack today.  The difference between by ruscksack and the Arsenal defence is that I can ensure my new one does not leak.

Unlike the Arsenal defence.

We had issues with defending on the weekend when we made things easier for Everton.  And we threw away our lead in Europe.  We had done the hard work by getting a vital away goal and keeping a clean sheet.  All we needed to do was to defend.

And in the last few minutes we went from this

What would we do without you! @Aubameyang7 😘😘😘😘 pic.twitter.com/08rGjGQU9e

— Ian Wright (@IanWright0) February 27, 2020

To this.

pic.twitter.com/pvd3xw8vT4

— Ian Wright (@IanWright0) February 27, 2020

Well, my new bag will not let as many things through...

What do I do if I think I have Coronavirus?

Today, I saw someone who mentioned to me that they were concerned that they had Coronavirus.

They ignored the correct advice on social media, the advice on the answerphone and the huge posters in reception which tell people that if they think they have it that they should stay at home and ring 111.

Two surgeries in North East Essex have been closed because of this and people who are worried about this, if they have it will spread this to other people by leaving home and if they have it, some of those they infect will die.

So, if you think you have COVID19, stay at home and ring NHS 111 and tell them your concerns. Do not leave your home unless you are told to do so by an appropriate healthcare worker you have told that you are concerned that you have Coronavirus.

TARDIS, not a Doctor Who invention, but the room of my son

I have decided that my son does not live in a bedroom, but instead lives in a TARDIS.  Over much of the last month, there has been a quest to tidy his room.  He has failed.  What was interesting, was not how much was stuffed down the side (and therefore under) his bed, or how empty drinks bottles were upstairs, or the wrappers for sweets which he is not meant to eat upstairs.  It was just how much stuff what somehow fit in his room which was either taken to the dump or the charity shop.

We have known that he is a hoarder and that there is a lot of junk in his room, but I just could not comprehend how much stuff he had in it.  I mean, where is it kept?  Anyway, it is clean now and hopefully, it will stay like that for at least a week.

On a football related theme, Arsenal have now won two league games back to back, three games if you include the Europa League game on Thursday night.  Sadly, the team did not defend as well as it should, but what was good was that Mustafi, who has come back with strength, was not the one to be making the mistakes!  I am hoping that we improve our ability to defend, or we will just make the defensive mistakes of the last two managers.

Is Boris Johnson racist?

To answer the question, no.

I do not consider Jeremy Corbyn to be antisemitic despite the way he has shared platforms with antisemites (and similar actions).

Boris Johnson has said racist things and has employed those who expressed racist views. And when it comes to this racist comments, they include the columns about African children looking like “flag-waving piccaninnies,” “watermelon smiles” and even describing a group of Ugandan children who once sang for him at a ceremony in Uganda as “Aids-ridden choristers?” And I know that this is controversial, but his deportation of foreign criminals was not racist in my view, but there is an argument that denying some of these people of colour, proper legal representation was.

Labour fell into his trap by fixating on the wrong matter when it came to those deportations.  Most members of the public will be in favour of the deportation of foreign criminals.  Labour should not have focused on that as they came across as being in favour of the rights of criminals and illegal immigrants (even though these people were not so) and the Tories came across as being tough on crime and also being firm on immigration.  What they should have discussed was denying people of the correct legal protections.  Most people will be against the denial of legal rights just based on skin colour and Labour should have focused on that.

So while I do not think that Boris Johnson is racist, he is guilty of using racist language in the past and he is certainly guilty of pandering to prejudice when it comes to gaining votes.

Storm Dennis

We had a weekend away.  After working on her dissertation it was the least that my wife deserved. So we went to Bicester for a the night.  But we had not taken Storm Dennis into account.  The drive there was fairly uneventful and we went to the shopping village.  

Afterwards it was a short trip to the hotel.  Our intention has been to swim, but my daughter had forgotten her swimming kit but when we realised that we would have to walk outside our enthusiasm dimmed.  However dinner there was amazing. The drive back was a bit draining and not as bad as the iconic plane landing that has been shared on social media.  We did see some flooding, but nothing compared to what a lot of the country has seen.  

Anyway, now relaxed I am waiting to watch the football and am looking forwards to work tomorrow.

Valentines 2020

Today has been one of the more interesting Valentines days.

I had taken a few days off this week so that I can help my wife with her dissertation.  On Monday, I still went into work to catch up with paperwork anyway, but my wife did not need me then.  My next day off was Thursday and while I did not help that much initially, I did have to proof read later in the day.

Our children were expecting us to have been arguing by the time they got back from school, but we were fine.  The arguments did not start till later.  And they continued until we finished, which was about 0230, Friday morning.  We had to wake at 0630 to put the bins out, and while my wife made some final amendments I went back to bed.

I woke again after the kids had gone to bed for I was to have a haircut and my wife and I met at GreyFriars in Colchester for our Valentines lunch.  It was great to spend the time together and the food was amazing, back to the standards that it was when it had opened.

Sadly, I went back to sleep again when we got home for I was to be a taxi service later.  My daughter had a party to go to and I was to drive her the thirty minutes to Groton in Suffolk for the party that she has been invited to.  On the way, we noted that we were driving in a convoy as several cars were making the same journey, though one took a wrong turn at the last moment.  We all went with her there, but I am to collect her in a moment.

Yo, I'll tell you what I want, what I really, really want (February)

At the moment I am after a lucky trade for a high CP Shelmet and/or Karrablast.  But in addition to this, I am also after a lucky trade for a Altered Forme Giratina to use in PokémonGO player vs player battles.  

My list of additional Pokémon that I am after is below.  I am aware that I may not be able to get some of them in high CP forms, such as the Alola forms of the Meowth or Vulpix, or Klink, but I guess my view is if you do not ask, you do not get.  I do have some high CP forms of some of the Pokémon that are on the list but the actual statistics that they have are wanting. 

Abra

Absol

Aipom

Azumarill

Baltoy/Claydol 

Bronzor/Bronzong

Burmy

Clefable

Drilbur

Duskull

Foongus

Geodude (normal form)

Goldeen

Golett/Golurk

Growlithe

Heracross

Horsea

Klink

Magmar

Mankey

Meowth Alola form

Murkrow

Nidoran♀

Nidoran♂

Oddish

Onix

Pidove

Ponyta

Porygon

Scyther

Shieldon

Squirtle 

Tanglea

Tentacool

Vulpix Alola form

Yamask

Yanma 

Sadly, I do not have as many shiny Pokémon as I would like, and those that I have tend to be those that others have anyway.  Which means in general that I am after like for like trades.  However, after the December Community Weekend, while I do not have many, I have a few evolved Pokémon with community day moves available to trade, some of them being shiny ones!

Could ACE inhibitors offer some protection against catching coronavirus infections?

[Edit]Since posting this, it appears that ACE inhibitors increase the risk from COVID19.[\Edit]
Needless to say, working an a GP surgery, I have been concerned by the latest news that a surgery shut down and that two doctors have caught the strain of Coronavirus that has caused so much death in China.

Looking it up, I noted that, according to Wikipedia, when it came to SARS, another type of coronavirus, the primary human receptor of the virus is angiotensin-converting enzyme 2 (ACE2).  With the current viral strain threatening the world, again according to Wikipedia, publication of the 2019-nCoV genome led to several protein modeling experiments on the receptor binding protein (RBD) of the spike (S) protein of the virus. Results suggest that the S protein retains sufficient affinity to the Angiotensin converting enzyme 2 (ACE2) receptor to use it as a mechanism of cell entry.

A link between a drug involved in this and a reduction in pneumonia has been noted in the past, this being ACE inhibitors.  It may be that the reason for the reduction in this is because of the ACE cough that can occur. But it may be that this has some protective effect by interfering with the entry of the Coronavirus into cells.

Sadly, I have good blood pressure control so am not eligible for treatment with an ACE inhibitor.  But for those who are on them, it will be interesting to see the outcomes when it comes to mortality compared to those who are not on one.

Colossal

I enjoyed this film.  Just a word of warning though, if you want to watch it, do not watch the trailer.  It does not spoil the film as much as other trailers do, but it does a bit.

For a science fiction film, this was different compared to what I normally expect.  It touched a few issues such as problem drinking and while it did not do well at the big screen, I would recommend this for sci-fi nerds such as myself who want something slightly different.

I was impressed with Anne Hathaway though, normally so glamorous, she fitted this part really well.

An alien civilisation

I have found the aliens who have put the rubbish down the side of my sons bed.

They had created a civilisation in the radioactive wasteland that exists there.  I suspect that there were several there making use of the unique ecosystem(s) in the world underneath his bed, but due to the great ‘Underbed war’ only one species survived.  But in a lesson that the rest of our planet must learn, they too destroyed the environment they lived in.  And now they too are extinct, and all that remains are the ‘Underbed wastelands.’

The Labour Leadership

Today the Colchester Labour Party made its choice regarding who it is nominating for the Labour Leadership contest.

I have watched most of the hustings for the post of Labour leader (I have yet to watch the deputy leadership ones) and the person I was most impressed with was Lisa Nandy.  While one person in the meeting claimed that all the candidates are uninspiring, I disagree.  Many spoke out about the different candidates who have inspired different members.  But overall, I have to say I back Lisa Nandy.

Boris Johnson has created a vacuum when it comes to politicians speaking to the public by refusing to speak on the BBC Today programme or Good Morning Britain.  I know the reason why, and that is because he will be challenged over his repeated lies and half truths.  And that offers Labour a huge chance to get its message across.  Jeremy Corbyn failed to engage properly with enough of the media frequently enough to get the message of how Labour can benefit the nation.

But when it comes to the leader, Labour has to pick one who is able to get that message across to those who have stopped voting Labour and those Labour needs to turn in the target seats.

Rebecca Long-Bailey is amazing at communicating with the Labour core.  She is able to inspire those on the left of the party, but my fear is that her choice of terms will continue to repel voters from Labour.

Emily Thornberry has shown her ability to communicate over and over again at PMQs and has been devastating when she calmly savages the government members who are sacrificed at the despatch box.  But my concerns relate to that tweet as well as her ability to get her message across to the voters Labour needs to attract.

The ability and experience of Keir Starmer is without doubt, and to be fair, at the moment he is my second choice.  He is a great communicator but his strong pro-remain views may hold Labour back with him as leader.

I feel that Lisa Nandy has that ability to communicate to those who Labour needs to appeal to.  I have been impressed with her honesty over difficult questions and her refusal to condemn either the Blair/Brown years as well as the Corbyn years.

She is new blood and I do think that after the way Labour tried to emulate the disastrous Tory campaign of 2017 in 2019, the last thing that is needed is a continuity candidate, but rather one who can heal the divides of Labour and bring in new, competent blood into the party.

It was not me

My son was meant to clean his room.  He did not.  And when my wife found out, she was slightly annoyed.  To make things worse plastic bottles were found down the side of his bed.  When challenged about this, he said it was not him.

Talking about it at work, the same issue happens with a fourteen year old son of one of the ladies who I work with.  All sorts of things appear in his bedroom which he did not put there either.  So we worked out that there were two options.  One is that my daughter has put things in my sons doom and has gone to the house of a boy she does not know to put things in his room.  Or that it was aliens.  No other explanation is really possible.