Matt Hancock sounds like a quartermaster, says ex-head of Army medics

Matt Hancock sounds like a quartermaster when we need generals brave enough to change the battle plan to win the war against coronavirus, says the former head of Army medics

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DR MICHAEL VON BERTELE is the former Director General of the Army Medical Services

We all know the saying: ‘We won the battle but lost the war’ – and that is what could well happen with the fight against coronavirus. 

King Pyrrhus, from whom the term Pyrrhic victory was derived, might have defeated the Roman legions in many battles, but found the cost of doing so too high, and so he gave up his campaign. 

We cannot afford to do that in the fight against Covid, but simply defeating it is not the endstate.

Military commanders are taught always to reconsider what their ultimate goal is; asking constantly ‘has the situation changed?’ 

That level of questioning is sadly missing from the daily government Covid-19 briefings that are being inexorably drawn into arguments about tactics and resources. 

Listening to the Health Secretary at the daily briefing, he sounds more like a quartermaster promising to get more rations through. 

While vitally important to this battle, provision of PPE and testing is not the ultimate goal. He knows that but has become too defensive. The whole Cabinet should revisit their strategy more publicly.

Health Secretary Matt Hancock (pictured at Downing Street in London this morning) sounds more like a quartermaster promising to get more rations through

At the outset of the pandemic it was clearly expressed and understood that it was necessary to flatten the curve of cases and deaths so that NHS resources would not be overwhelmed.

That gave rise to an army of armchair epidemiologists focused on interpreting the curve, but what is the enemy doing now? 

He has successfully fixed battalions of NHS workers, drawing the fire but diverting attention from the important role of the NHS as a whole. 

It is a health service for everyone, but access for all is in danger of being denied or vastly restricted. 

It is therefore vital that the government reviews its strategy and focuses on the end state, not the current battle. That will require some difficult but different decisions that must be clearly communicated to the public. 

They must lift their sights from the curve and the daily death toll, and the tactics of providing resources, and look beyond what is happening now. 

The new Nightingale Centres (including the one pictured in Birmingham) should be prepared to scale up and down locally and regionally in response to outbreaks as they occur 

The enemy will continue to draw us into many small battles for the foreseeable future, attacking wherever a weakness appears. 

It will be aided by incautious contact between and with those infected. Controlling that contact is only one part of the campaign and should no longer dominate our strategy. 

In military terms it is sometimes necessary to identify an enemy stronghold but use the minimum amount of resource to contain and bypass it while moving on in the direction of the ultimate goal. 

Those pockets of resistance can be revisited and dealt with later. The campaign must identify many lines of development but always focus on a clear goal. 

That has to be resumption of economic and social activity as soon as possible. Restoring the NHS to its primary role is vital ground but only one aspect of the campaign.

Covid-19 is with us for the foreseeable future. It must not dominate our hospitals and health service for a moment longer than is necessary. 

If it needs specialist capability to fight it, that should be separated from normal activity and if necessary the new Nightingale Centres springing up around the country should be prepared to scale up and down locally and regionally in response to outbreaks as they occur, and there will be many before the promised vaccine is available. 

This will require a significant change of direction. The basic principles of outbreak control must be brought in to play at the same time. 

A focus on identifying cases with accuracy and tracing contacts, and if necessary quarantine them, not punish the whole population, must be a priority. 

Schools must be opened as soon as possible to allow parents to go back to work, but if cases are identified among pupils, local quarantine can be imposed and contacts traced. 

It may also be time to impose restrictions or checks at borders. Not to prevent people from entering the country, but to impose basic, and in some cases stringent, controls on movement. 

Is it right that we still allow unrestricted access to those arriving from known hotspots or is it just too difficult to control? 

Should those people go into voluntary social isolation or should they be allowed to move seamlessly through society?

There is no doubt that many more of us will catch this disease before it is over and no one doubts the severity of suffering endured by those who do, but that does not justify the unseen suffering of the many thousands of patients with cancer, heart disease, strokes, diabetes and the many additional ills of the whole population. 

Perhaps it is time to recognise that the government cannot protect us from every threat and we shall have to make individual choices about the risks we take, just as we decide whether to drink, smoke, drive, ride a motorcycle or climb a mountain. 

What the public needs is education about assessing risk and mitigating it. We do not need the government always to make those decisions for us.

The government may be following the science, but science does not lead or direct how a campaign should be fought. 

It informs the commander but is only a part of the intelligence on which he should rely. Nor must it be allowed to excuse the absence of vision and debate that is needed now. 

As we await the return to duty of the Prime Minister, it should be clear that strong leadership will be needed, not slavishly to follow the trail laid by scientists alone.

Dr Michael von Bertele, CB OBE FRCP, is the former Director General of the Army Medical Services and a former World Health Organisation pandemic adviser

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