EDITORIAL – 22nd May 2020

ALARP

Allow me to introduce you to an acronym from the world of health and safety which helps staff to understand and design response to risk. It is ALARP – As Low As Reasonably Practicable. It is accepted that ‘reasonably’ is open to interpretation but the acronym and approach has stood for a considerable period of time.

I choose this as the topic for this week’s editorial because I am growing increasingly frustrated about testing – and the extent to which national intent is taking priority over local necessity.

In a country where we know there is a finite quantity of testing reagent available, I am struggling to understand the motivation for political targets of first 100,000 tests per day and now 200,000 tests.

If you are a manager working, for example, in a radiology department, your capacity to conduct CT tests is not limited merely by the availability of scanning machines. Right now it is also limited by an ability to abide by guidance relating to possible Covid19 contamination and the potential need to clean the machine after each scan. If you could test each patient scheduled for scanning on a particular day, you would know whether a deep clean after each scan was necessary – and for many / most it wouldn’t be. Alas, in the rush to fulfil a 100K per day national target, sensible scrutiny of when, where and why tests are required is over-ridden.

The target hitting mentality is a huge source of concern for many of you. 100,000 or 200,000 tests (or 25,000 track and trace contact workers) we know is arbitrary and doesn’t deliver on outcomes. The president of the Institute of Biomedical Science, Allan Wilson, has commented that knowing where, how and how often people will be tested is more vital than goal setting. He is right. And for those of you managing services in your health and social care environments, his words are even more adroit.

The next challenge facing us is how and when we start to open elective surgery units. Without testing based out of the hospital laboratories and subject to the turnaround speed they are capable of achieving, it is impossible to understand how elective activity can be quickly and effectively opened. The Royal College of Surgeons of England has issued guidance in respect of renewing elective surgery as follows: “Hospitals should know their diagnostic testing availability and develop clear policies for addressing testing requirements and frequency for staff and patients”. In other words, don’t restart elective surgery until you have a plan for testing locally.

the need to entrust local managers and staff with developing strategies and plans for risk reduction in respect of Covid19 extends to their being listened to in regards testing volume and focus. Whitehall (and the other devolved nation government seats) seems to be relishing its role as designer and broadcaster for pandemic instruction, but it is doing so in a manner which does not reflect the local realities and challenges faced. If we really want to get things moving and advance our health system whilst adopting an ALARP approach to risk, then the solutions rest locally – and not in politically expedient target setting based on national volume.

Do please write and tell me your own experiences of local testing availability and focus – jwilks@ihm.org.uk.

Stay safe, stay strong and thank you for the brilliant work you are each doing.

Jon Wilks

Chief Executive – IHM