NEW: remember the rush to build basic ventilators? Two experts involved and a Team leader go on record to try and share ‘lessons learned’ from what one called a “village hall” competition - and the need to repeat. Stay with me. 1/thread. https://on.ft.com/3ds0bha 

Let start at the beginning and this contemporaneous report from @ft on March 16 which said ministers were scrambling to design a British-made ventilator "from scratch". /2

https://www.ft.com/content/7ebb238c-67c7-11ea-a3c9-1fe6fedcca75

That was date @BorisJohnson held a teleconference call with captains of British industry - the Dysons, Rolls Royces, the Airbuses etc - to launch a Ventilator Challenge to create a new, quick, cheap ventilator - alongside efforts to import and step up UK production/3

This garnered headlines, but the question has always been, 'was it a good idea' trying to reinvent the wheel?

Was it good for patients? Did it harness the capacity of UK industry to good effect? Did it augment or, ultimately, distract from the efforts to prepare for #COVID19?/4

No doubt there was a crisis on. There were fears that UK would be thousands of ventilators short, so was 'any ventilator better than a bad ventilator'?

There was understandable panic/push...but did the government respond sensibly by starting this programme? /5

A window into this comes from the independent panel convened to assists teams through the regulator process after the Regulator, the MHRA, put out a specification for devices competing in the Ventilator Challenge on March 18. But by April 5, they were ringing alarm bells /6

In an April 5 memo to the regulator, seen by the FT, the group warns that drive to build thousands of basic ventilators risked wasting resources and delivering “worse patient outcomes”. Not just 'any ventilator' will do. /7

The problem, as one doctor involved said to me, was that the initial MHRA specification - while covering a wide range of features/options - wasn't clear enough about what was needed. To use a car analogy, the spec ranged from a 'Model T' Ford, to a 1974 VW Golf to a Golf 2019../8

So while clinicians like the ICU boss @AlisonPittard were clear they didn't need a Golf 2019, that they could get by with a 1974 model for a short period, the most basic interpretation of the spec was (as she told me) "no use whatsoever" /9

https://www.ft.com/content/365529f8-bff3-41d2-949f-d0eedff0cfbb

The expert panel in the April 5 memo warns that the wrong kind of ventilators were being prioritised - and by April 10 the specification is modified to say “the greater proportion of devices” need advanced features such as "spontaneous breathing mode" that react to patients /10

So as one of the signatories @hamilton_sara Dr Sara Hamilton tells me, while the teams were coming up with brilliant ideas for @BorisJohnson challenge "it was clear that we were going to end up with products that were not fit for purpose" /11

A second signatory, Dr Matthew Rooney, an NHS consultant anaesthetist, also praised the work and ingenuity of the teams, but said it was clear that the more basic designs could actually "harm some patients more that using other means of support" - like oxygen therapy /12

So what about the view from a Team - one of those consortia that responded to the governments "call to arms" - @MattHancock memorably invoking the Blitz spirit in an oped that weekend - how did they feel? The answer is pretty surprised the govt wanted to do it this way. /13

Prof Andrew Farmery of Oxford Uni led the OxVent @OxVent team - he's experienced with medical device making and "at first I didn't take it seriously" - running a "village hall" competition. I mean why not just get experts and industry in a room? /14

https://oxvent.org/ 

Prof Farmery's remark reminded me of the boss of GTech, the Worcester-based "home and garden appliances" maker who was asked to help. "I though it was a hoax". GTech was quickly dropped, but it shows perhaps the thinking. How wide the net was cast /15 https://www.worcesternews.co.uk/news/18322604.i-thought-hoax---worcester-company-race-time-build-life-saving-ventilators-coronavirus-patients/

The government has vociferously denied the charge of "muddled thinking" - see link below - and correctly points out that the spec did evolve and the ventilators did (in the end) get spontaneous breathing modes. None were ever needed. /16

https://www.gov.uk/government/news/response-to-ft-article-and-twitter-thread-by-peter-foster

Ultimately the #COVID19 peak passed & NHS capacity wasn't exceeded. No harm done.

But as we ponder why @BorisJohnson govt seems to be at the bottom of so many Covid19 league tables - the tracing App debacle, the PPE shortages, the death toll - what does this episode tell us?/17

In Dr Hamilton's view the govt “failed to create the right conditions to harness... UK industry, regulators, engineers and intensive care representatives,” she said.

So why didn't, as Prof Farmery says, they just get the 'nerds in the room'? /18

One day a Public Enquiry will try to answer that question; and try to quantify what such as scheme cost - not just financially, but in terms of distraction and misplaced effort (and I don't dispute the sincerity of the effort) just perhaps the clarity of the thinking. /19

Why did the UK think it could launch an Apollo-19 style great leap forward type campaign to invent, in six weeks, what had already been invented? Was it really our 'finest hour'? Have similar mistakes been repeated with the track and trace app? Will we learn lessons? ENDS