On Isolation, being prepared and the NHS

As I write this we are in self isolation, in response to the Coronavirus. The situation is exposing the risks of much of the ‘Just in Time‘ world wide flow of goods and people which we normally take for granted to view. As the situation is unusual, many people have panicked and stockpiled things they think they might need. Unfortunately their system for deciding what to stockpile seems to be based on buying as much as they can of whatever seems to be in short supply, particularly toilet roll – thus creating a supply shortage.

Oil Rigs

The situation reminds me of some lessons from my past. From 1987 to some time in the early 1990’s I worked on an oil rig on the Hutton oil field in the middle of the North Sea.

I worked there in stints of a fortnight at a time, doing, as most of the crew do, a 12 hour shift, 7 days a week, although as the work was extremely interesting, and I did not have much else to do, I tended to work longer. I learnt a lot about many things, but of particular relevance to our situation was the way the rig was always prepared to be self sufficient in dealing with problems.

Travel to the rig involved a helicopter flight of several hours, and weather conditions could be extreme. I remember one landing where the wind was so strong that the pilot had to use the rotor for downforce, rather than lift, to keep the helicopter on the helipad, and the passengers, and their luggage, were passed along a chain of crew to the stairs down into the accommodation. If the wind had been any stronger there would have been no way on or off by helicopter.

Supplies arrived by ship, which stood to, near the rig, and pallets were removed from the hold by skilled crane operators on the rig, whose cranes could pull a load off a ship very quickly, as once the load was being carried by the crane it had to be moved out of the way before the ship came up and smashed it. Again, in a heavy sea there was no way on or off the rig by ship.

The systems on the rig were designed with an expectation that it could, if necessary, be self contained (i.e. in isolation) for up to a month. This meant holding spare parts for everything which might need it. My own work was the ultrasonic inspection of the legs of the oil rig, which was done by a winch lowering a complicated and expensive probe down a 75mm diameter hole in the centre of each leg. There were two probes on the rig, the one in use, and a spare, plus a full set of spare parts to replace any component which failed. There was also a well fitted out workshop, so when a component – luckily a common one, failed on a CAMAC module, I was able to replace it rather than have to wait for a new module to be flown in.

The rig was powered by two large generators, either of which was capable of powering the rig in production on its own (or a small town), plus a less powerful stand by generator. The need for this level of redundancy, and the way that, as a colleague of mine used to say ‘Murphy is always vigilant‘ was demonstrated one time I was out there, when one of the main generators was ‘on the beach’ – i.e. it had been taken off the rig and was onshore for a major overhaul. The main generator failed, and there were problems starting the backup generator, so the rig was running on is large bank of backup batteries. I shut my systems down, as they were in the control room, but not vital to the running of the rig but using its batteries, and waited in the emergency lit accommodation for the generators to be repaired. During this time a very wet worker entered the accommodation, as he had been in a compartment where the batteries had not been powerful enough to keep the deluge fire suppression system from operating. The problem was fixed – by engineers already on the rig, and life in the little closed world returned to normal.

There was not only redundancy in equipment. The regular crew were all trained in more than one job, so could cover if someone was sick, and workloads were designed to ensure that normal operations were calm and well organised – so that there was slack in the system available for an emergency.

The NHS

Unfortunately budget constraints have squeezed the slack out of the NHS, even when they were operating under normal conditions. This is partly due to confusion over whether it should be treated as a set of isolated parts or as a single entity, even a single ‘superentity’ combined with the social care system. For budgetary purposes elements of the NHS, for example NHS Trusts or GP practices, are regarded as targets for budget cuts if their resources do not match their normal load, but if there is a sudden peak in demand they are supposed to be able to deal with it by diverting demand elsewhere – but the financial systems actively discourage this.

If we want our NHS to be able to deliver excellent service then we must build slack into the system.

Service excellence, spare capacity and virtuous cycles

At one time I was involved with managing an expensive supercomputer system. The support staff spent quite a lot of time apparently doing nothing, but training and learning. This meant that when there was a problem they could react quickly and knowledgeably. These large systems generally ran Unix (from which the the Linux system I prefer was derived). This is used in places where reliability is very important, and tended to run for many months at at a time. Because they were so reliable they could be monitored very carefully, and any problems investigated in depth. This created a virtuous cycle where minor potential faults could be fixed to make the systems even more reliable.

At another time in my career our over-stretched team were sent on a ‘Service Excellence’ course. One of the examples the instructor gave of excellent service was a company being unable to deliver a washing machine at the agreed time, and excellent service would be to not only reschedule at a time convenient to the customer, but then to plumb it in for free. They conveniently ignored the fact that if the team is already working at capacity, then other customers will not receive their washing machines as the delivery team will need to cancel other deliveries to meet this expectation. A vicious circle.

Regulation

One of the themes which drives the world as it is today is regulation — in the meaning of the management of complex systems according to a set of rules and trends. With my science/engineering background I tend to think of it in terms of control theory, or like a regulator on a steam engine.

There are some key parts to the feedback loop as they relate to the Coronavirus, and the issues it has shown up.

Measurement/Detection

This is vital to any kind of control loop – we need to know something has happened before we can do anything about it.

Lag

How long does it take between measuring something and being able to do something about it

Action

On the basis of what we know from the measurements, what do we need to do.

Regulating Coronavirus



In the context of coronavirus, the experience of South Korea has shown how important testing is. Coronavirus, like most infectious diseases has its own feedback loop, in which each infected person infects more people, and in the absence of a good information about the disease, the only way we can control it is through the blunt instrument of isolation. This has a significant economic impact on the country – or world in general.

Regulating the NHS

The inherently long delay between detecting a problem and being able to act on it is very significant in the context of the NHS. Our modern, connected society has led us, and our politicians, to operate as if, once a problem has been detected, it can be solved quickly – our electricity goes out, we contact our supplier, or an electrician and soon we have electricity again. The expectation of a quick response means that we do not need to prepare for this. My family had a cottage in Argyll, where we knew that we had to be able to manage for some time without electricity, so we had firewood, hurricane lamps and a camping stove to mitigate the problem.

The NHS fairly quickly identified that it did not have as much of some kinds of equipment as it would need, and if we had either been a fully self sufficient nation, or the worldwide market had been normal then this could have been rectified more quickly; although still not instantly – it would have taken time to switch our respirator factories to three-shift working, or for container ship loads of respirators to arrive from China. As it is there is a longer delay while factories change the type of item they produce and there is international competition for purchasing all forms of medical equipment.

The time lag between knowing that we do not have sufficient doctors or nurses and them becoming available is several years, which is, unfortunately, further than the attention span of some politicians. A possible short term fix is to recruit already trained medical personnel from abroad, although some sections of our society seem to be determined to sabotage this approach by being as unwelcoming as they can to anyone coming here from abroad.

Shortages of doctors or nurses put extra pressure on those who remain, who are more likely to become unwell from stress,

Diversity

Another theme running through my mind at the moment is the importance of diversity, and how we retain cohesiveness and diversity simultaneously.

The crew of the oil rig was remarkably diverse, and yet, as a small community, everybody worked well together. Keeping an oil rig clean (in the accommodation and working areas) requires constant hard work from the cleaners. Being there for a fortnight, with only a flight bag, meant that everyone was grateful for the unobtrusive overnight (or I assume overday for the night shift) way you could leave your laundry outside your cabin and it would be returned clean by morning. I got to know the people running the ‘ship’ side of the rig quite well. Many had been working on oil tankers, so seeing their family for a fortnight every other fortnight was a boon to them. They tended to be quite, steady and unflappable family men, from all over the country. The scaffolders were a slightly rougher crowd, younger, largely from Glasgow, and using the f-word as every other word, but very friendly and good natured. Like everybody they took their work very seriously, being the only people allowed to work outside the main body of the rig without being on a certified scaffold. The range of professions was fascinating ; Drillers – huge strong men who helped manoeuvre the sections of drill into place, I saw one carry two plates heaped high with food to the table and work his way through them ; Reservoir modellers ; Explosives experts ; Underwater submersible pilots – all fascinating to meet.

Working in such a close community, there was no room for social differences – I saw the OIM – the Offshore Installation Manger, playing table tennis with one of the cleaners.

If any good is to come out of this pandemic, I hope it will be to realise that, in our diverse world, we can, and must come together (figuratively, while still maintaining social distance), that we all have a role, are valued, and value and respect our neighbours in return.

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