The moment the Prime Minister decided to place a number of areas into Tier 4, it became a racing certainty that the rest of England would be in full lockdown by January. The nature of this new Covid variant has changed the terms of our response and I accept that the Government has had to take action even if I have deep concerns about aspects of the course it has chosen.
However, it is clear the Government has now put all its eggs in the basket of the vaccine roll out. The way out for the country hangs on the role out of these jabs. The Prime Minister has rightly demanded of ministers and the NHS that they vaccinate the most at risk members of the public, some 13.4 million people, by the middle of February. That would require the Government to be vaccinating a minimum of 2 million people a week. This is an enormous task.
It is therefore entirely commendable that the PM has appointed a dedicated minister, Nadhim Zahawi, to oversee this task. It is especially welcome that he chose one with the useful experience of having run a global business before entering politics. Yet, even with those credentials, Mr Zahawi knows that to achieve the the task set by the Prime Minister he will have to have the most robust of institutional structures and the powers necessary to overcome the normal inertia, particularly that occurs between government departments.
This must be treated as a military operation. He must be clear what the real objective is and make it clear that each person must understand this, all the way down the chain. "Maintenance of the Objective", a principle that Mr Zahawi would do well to borrow from the military, cannot be forgotten and an assessment of whether the roll-out is on track but must be made daily. To that end, it is good that 101 Logistics Brigade are now embedded in the process. The military bring key command and control skills, an area in which the Civil Service is typically poor.
The main problem is that Civil Servants don’t by nature tend to meet targets. They typically end up giving ministers overly optimistic objectives and then later reporting back failure once it's already too late. This is because once they set a goal, they often then leave it to those tasked with carrying out individual assignments to report back up. Without critical interrogation along the way, problems get hidden and the targets get missed. Examples of this are endless but the test-and-trace app would be one recent example.
Mr Zahawi will need, on his desk every evening, a report direct from each area of command, town and district. These will be compiled by the "contract managers" whose responsibility it is to deliver their area. This report should include their targets for that day and week and whether they are on track to meet their broader targets. If they are off, then they must report what they are doing to get back on track. Two days of missed targets should trigger urgent intervention. It is this feature most of all that should occupy his daily meetings. If medical centres are going to be used to organise vaccinations and call people in, then the deliveries of the vaccine must be there on time, otherwise chaos ensues.
As the PM has put him in charge, he must have the power to demand that individual Secretaries of State account to him for their compliance with the plan. The PM will need to work hand in glove with him on this. Individual departments must not be allowed to drag their feet or have other priorities. Perhaps the best example of where this has already occurred is the delay in getting retired doctors and nurses in to carry out the jabs. The NHS has known about the ridiculous amount of compliance these people were being put through, yet dragged their feet on resolving the issue until this week. The revelation that PHE staff were not planning to work seven days a week, a situation that has since been corrected.
On top of that, there is a long list of organisations that need to be on board in the role out. Pharmacies, with pre-existing venues and skills in administering vaccinations. Could coffee shops, pubs or even schools, closed now but with easy access and refrigeration, be used as sites for vaccines? They could even use Job Centres, as the authorities have in Israel, drive-in centres and mobile vaccination units.
However, the issue which has the capacity to derail the objective is that of supply. There is some evidence of a problem in the supply of glass vials where there seems to be a shortage. The vaccine manufacturers deny this and say they are on track to meet the need for two million doses a week, but it isn’t certain when that will be. In time for 13.4 million to be vaccinated by mid-February? If so, that means next week.
The simple truth, and what may prove to be the Government's greatest headache, is that I don’t think 2 million vaccinations a week will be enough. I suspect that it will need to be at least three million on a reducing timescale. If such a compression of the timetable takes place, there needs to be a back-up plan to cover it. From production to inoculation, the potential to scale up must be there, including 24 hour vaccinations.
Urgency is the key and to that end Nadhim Zahawi should insist that everyone in government, from the Prime Minister down, should now have on their desk a note saying: "Action this Day!"
This article was published in The Telegraph.