Health and Social Care

Drakeford’s Deficient Data

Much has been said in the last weeks and months about data. Colin Powell, the former US Secretary of State, once said “Experts often possess more data than judgment”. During the COVID-19 pandemic, politicians have been using data to make their decisions and making some of it available online, writes Crispin John.

And lo and behold, everyone’s become a statistician, as well as an epidemiologist. But what is the data we’re seeing telling us? And is it the full picture?

When we had the briefing from Downing Street on Saturday evening, the Twitterati were out in force to berate the quality of slides used by Boris’s boffins. They were, of course, correct. Much of the data was unintelligible and some was disappearing off the screen. Another way to look at it, of course, is at least the announcement was backed up with some visible data. We don’t seem to get that here in Wales.

Naturally, data is available online, but you really do have to hunt around for it – and there are stark differences in how data is presented across the constituent parts of the UK, and between organisations. There are also some noticeable gaps.

The R Rate

What we can see is that the R rate has increased since the first local lockdowns were introduced, and since the start of the academic year – but you can’t see that in March and April, the R rate was estimated between 2 and 2.5 – it would literally be off the scale of the above chart. Now that Public Health Wales have started publishing data on a more local basis, then surely they can break down the R rate to a more local level – for example by local authority area. One would think that this is already part of the decision-making process, but clearly that’s not information that’s been placed into the public domain. If the Welsh Government had wanted to justify why local lockdowns were necessary, then it might have been helpful if they shared the reproduction rates as well as the number of cases, to give a fuller picture of what was going on.

Clearly, they chose not to do that.

Critical Care Beds

In the days leading up to the latest Wales-only lockdown, we were told that critical care was “at capacity”. Analysis of the data published by NHS Wales, however, shows that at the moment, there are vacant beds across all health boards.

Again, this only shows part of the picture. As health services learn more about the virus, treatments have changed, and the First Minister himself has said: “the flow of people from hospital beds into critical care is not at the same rate as it was back in April. That is because there are more effective treatments earlier on in the onset of coronavirus”.

It’s been suggested, as well, that the reason critical care was deemed to be “at capacity” is because although there were plenty of vacant beds, there weren’t enough nurses to staff them. There’s no officially produced data on that – but what we do know is that in the first wave, staff who weren’t critically care trained were drafted in from elsewhere to support staff who were, to ensure that critical care had the support it needed. This isn’t a huge surprise, given that in normal circumstances Wales has around 152 general critical care beds. But we do know that there’s been a problem with recruiting, training and retaining these specialist staff within the Welsh NHS for some years.

Could this be why the Welsh Government aren’t so keen to tell us about staffing levels within the NHS?

Causes of Death

It’s inevitable that in all of this, attention will be drawn at some stage to morbidity statistics and it can’t be denied that we are seeing an increase in the numbers of patients sadly dying from COVID-19.

In both England and Wales, however, COVID-19 did not feature in the top ten leading causes of death in September 2020. In England, COVID-19 was the 19th most common cause of death and in Wales, COVID-19 was the 24th most common cause of death, for deaths registered in September 2020.  The Office for National Statistics says that, in fact, most causes of death are currently tracking at the five-year average.

We know that a growing number of COVID-19 patients are contracting the virus in health care settings such as hospitals and care homes, and we need to see more data on this to better understand the extent of the problem.
A further thought on this is that we do not yet know the impact of missed diagnoses of other conditions such as cancers because of cancelled appointments and delayed operations. We may not be able to adequately know the full extent of this for some considerable time, but it doesn’t take away from some of the heart-wrenching stories in the media about people who have lost loved ones in this way.

What else aren’t we seeing?

Anecdotally, we’ve heard that mental health services, already stretched before the pandemic, are at a tipping point. The impact of shielding on already vulnerable people, together with a lack of social interaction more generally, and the devastating economic impact of COVID-19 on many, has led to a mental health crisis in our country. And yet although the Public Health Wales dashboard tells us the number of weekly GP consultations for respiratory infections, asthma exacerbations etc., both serious issues in themselves, we’ve not seen data on mental health-related GP consultations or referrals to community mental health teams.

Surely in a pandemic of this nature, which has had such a wide-ranging and deep impact on our society, mental health issues should be taken just as seriously.

There’s so much more that we could be seeing, and which the Welsh Government probably do have data on, but they’re not sharing. The levels of personal debt are probably skyrocketing. We haven’t seen analytics from Apple, Google or phone companies, for example, to tell us how effective local lockdowns were – that has in fact been published periodically in England. We can probably assume that part of the reason the Welsh Government insisted on the so-called “firebreak” is that they knew the local lockdowns were not working and that people were breaking the rules. It would be a brave politician to accuse the electorate of flouting the law.

Maybe a braver First Minister, however, would be prepared to put his head above the parapet and tell us what’s really going on by sharing the basis on which he actually makes his decisions.

Crispin John is a political commentator and analyst, and former Chief of Staff for UKIP in the Welsh Parliament.

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