Closer to home UPDATED

Saturday I was very relieved because our daughter arrived home.  She had been on a language study trip for a week. In Italy.   Naturally I have been watching events there rather more closely than I might otherwise have done.  And it is disturbing in several ways, particularly as the Italian government response to the covid-19 virus was pretty good. Luckily daughter was not in the infected region and they weren't traveling back with Flybe.  Even when the schools were closed the language school she was at stayed open.  And when Easyjet started cancelling flights from Italy for lack of demand, hers wasn't affected.  They did a few visits of course to the tower at Pisa and to Florence, and judging by her account and the pictures those tourist sites were far less busy than normal.  That's was all before the latest announcement that the whole of the country is now in lock-down.


The statistics on the virus are tricky to interpret. Partly that's because of the 2 week or so incubation period which  you ought to account for in comparing numbers of cases with mortality and hospitalisation figures. Statistics from Italy and China over mortality rates and hospitalisations are also notably different. Two potential real reasons for that I can identify - demographics  and differing strains of the virus.  Demographics because the virus affects over 65's rather more severely than younger cohorts, so rates will appear higher in places with a higher average age.  If it should be because Italy has a different more aggressive strain that really troubling.  It implies it can mutate very rapidly and that is big trouble.  The  other possibility is that someone is 'managing' their official figures.


Something that is quite clear from Italy is that the symptoms are severe in a significant portion of the cases.  The mortality rates seem to be a touch below 3% and many people , especially younger ones, get mild symptoms and do recover.  But about 10% need intensive care.  And that is where the immediate stain comes - on the demands on the health system.  I don't know how prepared Jersey is in terms of intensive care capacity (facilities and staff), face masks etc.  I do know other places have been caught flat footed.  The State of Washington had to issue emergency instructions because they were about to run out of face masks in hospitals , and had been scrounging stuff from vets and even builders supplies to give to patients. Staff were instructed not to use them!


To my mind the response of the States of Jersey , like that of the UK and US governments, has been appallingly lax and ill informed.  Washing hands properly and working from home, if you are one of those non essential people who works at a desk, is fine.  But it is inadequate.  The latest comment I have seen from the Chief Minister was claiming testing at the ports wouldn't meet their requirements.  Possibly so if their requirements are unrealistic.  You won't stop the virus reaching us by testing like that.  There are at least two well documented instances of the virus being passed on by someone who is asymptomatic.  But testing everyone entering would shift the odds and also buy some time. Certainly the pressure on the hospital here would be lessened if we get past the seasonal flu period and have more time to arrange adequate intensive care capacity.  And yes it is possible to do it. Mongolia last week banned flights from high risk countries, Germany is testing  at some borders, including road passengers.  By comparison Jersey has limited access points so should find testing a doddle.  Israel is expected to go further and require all entering the county to go into quarantine initially.  Probably a step too far for us at this stage.

China and Italy have responded swiftly and strongly.   If the official figures from China are right they are getting on top of the virus spread.  Italy despite their efforts has not, yet.  I find it revealing to see those places that have taken strong action are those that have a tendency of putting citizens interests before those of business.  Places like the UK, USA and Jersey where the first reaction typically is to think of the economy are way less prepared, and have done little beyond issue the predictable trite 'don't panic', 'wash your hands', 'we are prepared'.

That brings me to a point where I think  the comments from the Chief Minister are most misguided.  He was quoted saying that if the economy did suffer we have reserves and funds to deal with it.  Yes there are reserves and funds, but no it wont be effective if this is a pandemic developing. There are two main reasons for this.  First, unless the funds are heavily skewed in the allocation to US treasuries and gold or well hedged with some short or inverse positions the values are dropping rapidly and will continue  as economies everywhere slow down. Second as economies falter and people get ill, the government costs rise -sick pay, unemployment benefits, while tax revenues tend to fall. If you think the government are going to use those reserves to prop up the economy rather than bailing out its cashflow, you are a bigger optimist than me!

Finally I want to point out something alluded to above. The choke points that can be used to test people entering. In that scenario they are an advantage. But in another scenario it is a problem.  Imagine just for a moment that the crews of the ferries to Jersey are quarantined for two week because they have the virus...

UPDATE . Call from school this morning that all those on the trip have to self isolate.  The info comes from update UK advice, but isn't retrospective there.  Jersey officials have decided to apply retrospectively.

Unbalanced futures

I inadvertently found myself listening to the States on Wednesday afternoon. It is a habit I thought I had overcome ! It was on the funding of the new hospital. I haven't followed the debate on the selection of the site, but I was interested to hear some of the points being made about the funding. 

 At one extreme was Deputy A Lewis who was arguing we should be borrowing more. The basis of his case was that with abnormally low interest rates it would cost less than the return on the funds we have invested. The amount of debt the States carry would be considered very low in business and more is affordable. At the other end of the spectrum was deputy Bree and Sen Ozouf arguing it is too much of a burden on future generations. The proposal was for a fixed interest 40 year bond. In all probability the value of the capital repayment will be significantly eroded by inflation, but its not guaranteed and we have had extended periods of deflation in the past. 

 Both cases are based on some degree of facts, though I'm bound to note there are companies, even quoted ones, that operate without debt. Taking on debt necessarily requires you to have a view that you will have inflation or income growth in the intervening period. Both are plausible over the next 40 years. And in many way that is the problem. 

I was waiting to hear someone raise the question over other commitments and problems we shall have to fund over the next 40 years. Problems that themselves stem from growth - the growth needed to afford repaying the loan. Not one mention of the issues of climate change, resource depletion etc etc. A whole assembly making 40 year future commitments as though somehow finances are isolated and independent of the realities of growth in the physical world over a comparable timescale is folly. 

Of course we are in a hole, there is no good solution from this position. Deputy Noel made a good observation here. The reason we had to borrow £250million (issue a bond) to sort out the housing problems was because we (The States) did not invest in the housing stock over the years. Similarly with the health buildings. I believe that is true. And there was a reason that was allowed to continue. We had for decades a mentality that the tax system was perfect, so the revenue available fairly static, regardless of the scale of the problems to be addressed. That was folly. It is one that we somewhat persist with . 

All these new capital projects have to be funded of course, but as ever when you launch a big building programme you are committed not just to the capital costs, but a significant amount of ongoing maintenance and management costs, at least you are if you are doing it properly. My problem is we seem not to have learnt, we are still not making adequate provision it seems for future commitments. And if we aren't doing that financially when the whole assembly is looking at the finances, what do you imagine is going on about ecology and sustainability where practically no member of the States takes a strong lead?

A coincidence or three

I've been doing some reading around our proposed new hospital. It is not my usual arena, but recent events have highlighted some aspects that should be input into the planning of the facility, which we can easily image should last the Island a generation or more. Intuitively one would expect population and demographic models to be central. The reticence of the Minister in laying out the details of the models used is troubling. But it is not the only area of concern.

The recently published IPPC report is quite clear there are expected health, including mental health impacts on small island states. The summary can be found at http://ipcc-wg2.gov/AR5/images/uploads/IPCC_WG2AR5_SPM_Approved.pdf . Unlike previous reports, this one explicitly identifies current impacts are occurring "Local changes in temperature and rainfall have altered the distribution of some water-borne illnesses and disease vectors”. A few other pertinent quotes are :

“The key risks that follow, all of which are identified with high confidence, span sectors and regions. Each of these key risks contributes to one or more RFCs.33

i. Risk of death, injury, ill-health, or disrupted livelihoods in low-lying coastal zones and small

island developing states and other small islands, due to storm surges, coastal flooding, and

sea-level rise”

“Impacts from recent climate-related extremes, such as heat waves, droughts, floods, cyclones, and wildfires, reveal significant vulnerability and exposure of some ecosystems and many human systems to current climate variability (very high confidence). Impacts of such climate-related extremes include alteration of ecosystems, disruption of food production and water supply, damage to infrastructure and settlements, morbidity and mortality, and consequences for mental health and human well-being. For countries at all levels of development, these impacts are consistent with a significant lack of preparedness for current climate variability in some sectors.”

I have written to the health minister to ask what extent these changes, both present and future have been considered in the planning of the hospital.

However I came across something else while looking for information. The hospital managing director is of course a pivotal person on the future of the hospital. So I did a search. A brief cv for Mrs. Helen O'Shea is on the States web site at http://www.gov.je/News/2012/Pages/NewHospitalManagingDirector.aspx . I used to do a lot of technical recruitment interviewing when I was running a rapidly growing software business. I've seen a lot of cv's. Two things about that online piece stood out to me immediately. While all the other positions held had accompanying dates, the time at Northampton General Hospital NHS Trust does not. The other is the repeated occurrence of acting or interim office for what look like exceptionally long periods. This naturally raises the question of why she did not become the actual chief? It might be as straight forward as a glass ceiling effect.

Perhaps that temporal absence is simply a stylistic choice by a content manager. However we can infer that Mrs O'Shea was there between 2004 and 2011, rather longer than the other establishments. A very long time to be an acting chief, so I assume some other roles and positions were omitted. Her public profile on LinkedIn is even less informative, listing only the current position. More useful is zoominfo http://www.zoominfo.com/p/Helen-O%27Shea/815893917 Here we can identify that in 2006 Mrs O'Shea was director of performance (not an executive director however).

A bit more digging and this came up http://www.northamptonchron.co.uk/news/local/hospital-names-boss-1-934551 from the 30^th October 2008. Mrs O'Shea it seems did not put herself forward to be Chief Executive, despite having been acting chief for six months according to that article. (So that clarifies one of the points above). Perhaps it is not too surprising that she didn't pursue the opportunity when you read this : http://www.northamptonchron.co.uk/news/local/hospital-halts-bid-for-elite-status-1-929196 I'd say that was the right decision to make for the acting Chief, but you have to wonder what responsibility the former director of performance and director of operations had for being in such a position of failing to meet standards and the public's expectations.

That wasn't the only problem the Trust had that year. In April it was all over the national press after a bogus nurse was in court. See http://www.dailymail.co.uk/news/article-1017370/Woman-walks-street-land-job-NHS-nurse-years--treating-hundreds-qualifications.html and http://www.northamptonchron.co.uk/news/local/robust-checks-made-on-nurses-1-925910 Whether the recruitment, appraisal and performance checks up to that point came under Mrs O'Shea's directorial responsibility I cannot say, but it cannot have sat comfortably given her immediate prior title.

Did the HR department and interviewing staff go to the bottom of those irritating and stand out cv points? Is it coincidence that in 2012 Jersey appointed a new hospital managing director who had experience of public glare due to a rogue or bogus nurse and a hospital failing to meet targets? Is it possible that the hospital, knowing they had problems with a rogue nurse, as exposed by Stuart Syvret, thought they had found someone who could protect them and 'tidy up' from the fall out? I have no idea. There is nothing of any substantive fact to show Mrs O'Shea to be anything other than a professional in her field. And yet there are those annoying coincidences and little questions that nag away at one's confidence.