I have now observed a Covid-19 vaccination hub from both sides. As a patient waiting outside in a three-hour queue, much of it in the rain, I wondered why everything was moving so slowly. As a volunteer doctor working on the inside, I saw numerous good-hearted colleagues trying their hardest, bursting a gut to make the system work. Why the difference?
I have concluded that the NHS approach to patient safety is a very significant contributor to vaccination delays. There has been national publicity around the mandatory training for potential volunteers before they can start work, which has included ‘diversity’ and ‘counter-extremism’ training. A friend who is a recently retired senior nurse was also told she’d need to do basic training in how to administer an intramuscular injection, something she’d been doing most of her life without incident. She snorted with derision and refused.
But it’s not just silly training rules before people start work. Inside the hub I watched as each patient was taken through lists of safety-related questions – often duplicated – before a needle was unsheathed. Could they have been given information and invited to answer the questions on a form while queueing? Could the laborious booking-in system have been made more efficient? Apparently not. The procedures have been defined centrally and we have to follow them.
I described this to a long-retired GP I know. That generated another snort of derision. He told me how he had once been asked to vaccinate all the pupils in a school. He and one assistant vaccinated them all, about 800 pupils, in one day.
The vaccination hub where I worked had six vaccinators, six booking-in administrators and a similar number of people managing the queue. There were also several ‘first responders’, there just in case there was a serious allergic reaction. (There wasn’t one, but despite their training they were not allowed to administer the vaccine. Nor was I, despite being medically qualified; I was there to give advice and write prescriptions). That whole team was expected to get through about 300 vaccinations in a day. That’s the total for the centre, not per vaccinator.
I described my GP friend’s anecdote to another member of staff at the hub. Their immediate response was ‘Well I don’t suppose they had to worry so much about safety in those days’. Which is probably true. But in the context of this pandemic, what does ‘safety’ mean?
At the time of writing, deaths due to Covid-19 are running at about 1,000 per day in the UK. The vaccination programme is widely agreed to be our best way to stop it. Which means that every time a well-meaning patient safety rule is introduced that delays the vaccination programme by a day, around 1,000 lives are lost. One thousand unnecessary, avoidable deaths.
That sort of ‘safety’ isn’t safety for patients. It’s safety for those who make the rules and run the system, who are trying to ensure that they are ‘safe’ from the criticism that will follow any adverse reactions or incidents involving identifiable individual patients. It’s not safety for the population of this country. It’s a death sentence for a random 1,000 people who get the vaccine too late or not at all. But they won’t know who they are, so they can’t complain, and no one can publicise their stories.
There will be those who claim that the problem is not patient safety or checks, but the resources available to the vaccination programme or limits on the supply of the vaccine. But when we are dealing with such a large number of vaccinations, small delays can still have massive effects. Let’s presume, for example, that a single 'patient safety' question takes ten seconds to ask, answer, and record. And remember that we currently have around 100 million vaccine doses to deliver. That ten seconds for each patient will add up to 1,000 million seconds of NHS staff time. That’s about 35,000 working days, or approximately 175 full-time equivalent staff working for a year. Is that extra ten second question really worth that kind of cost?
It is telling that the first country to vaccinate one fifth of its population, Israel, is reported to have spotted this flaw, and has introduced streamlined systems to maximise patient throughput. They lead the world in vaccinating their population. Can’t we do the same? As I’ve seen, the NHS is not short of good people who want to volunteer to help. But safety bureaucracy is slowing us down, and the delays are costing lives.