In the general election, I voted for Zöe Franklin (Lib Dems) not Angela Richardson (Conservative), and was happy when Franklin won, but to be fair I think Richardson took her responsibilities as a constituency MP seriously. A few months ago I wrote to Richardson to express puzzlement at some of the NHS’s guidance on preventing airborne diseases spreading. Richardson then forwarded it to the office of the then minister Maria Caulfield, who replied. The reply is at the bottom of this post as a pdf.
The reply is a curious thing. What has happened is that a scientist (me) has written to their elected representative (Richardson) who has passed it to another politician (Caulfield) who has passed it to either an NHS or Department of Health and Social Security employee, who is anonymous but hopefully has some relevant technical knowledge, i.e., is either a scientist or a medic. This anonymous person then drafted the letter which then came back to me via Caulfield and Richardson. This took around 5 weeks.
Compare this to what happened when I had some questions about a recent paper I found very interesting. I emailed the corresponding author who passed my questions on to the other author who did most of the work, and we had a very useful exchange of emails. This is a lot more efficient.
So the NHS/UK government is not adhering to what I would call best practice in science, i.e., put in the public domain what the results are – here the recommendations for infection control – together with the names of the authors, reasons for the recommendations, methodology, and references relied on. Weirdly, the outline methodology is public – there is a link to that in the letter – although nothing else is.
So, we have this odd situation that if you have a query about something of real public interest, infectious diseases spreading in hospitals, it needs to go through not one but two elected officials, and with a counterparty that remains anonymous.
My letter to Ms Richardson* included two questions, one of which was technical, and the letter addresses at least part of that. But the other question was:
2. What is the justification for the NHS developing guidance such as this in complete secrecy?
As you can see from the pdf attached to this post, whoever drafted the letter completely ignored this question, which I think is a little rude. I have now written to Ms Franklin, to point this out. We will see what happens. I did point out that it was very inefficient for everyone concerned that details of the NHS infection control policy apparently have to be extracted bit by bit via letters to an MP, who surely has better things to do.
* Dear Ms Richardson,
This is an email from a constituent (Richard Sear ….).
It concerns a somewhat technical topic – infection prevention and control (IPC) guidance given by the NHS, in particular these for measles: https://www.england.nhs.uk/long-read/guidance-for-risk-assessment-and-infection-prevention-and-control-measures-for-measles-in-healthcare-settings/ and the part
“2.3.2. Surgical face masks as source control
If the patient has confirmed or suspected measles, then if possible/tolerated the patient should wear a surgical face mask (type I/II/IIR) in communal areas (for example, during transfer). The request for patients to wear a facemask must never compromise their clinical care.
Note: FFP3 respirators or powered respirator hoods must never be worn by an infectious patient.”
I am a scientist with published peer reviewed work on how masks such as FFP2, FFP3 and surgical masks work (https://scholar.google.com/citations?hl=en&user=DXKy5bgAAAAJ&view_op=list_works&sortby=pubdate). This email is from me in a personal capacity, not on behalf of my employer.
The NHS’s statement that “FFP3 respirators” “must never be worn by an infectious patient”, but that a surgical mask should be, is simply bizzarre. There is a considerable peer-reviewed literature, plus the FFP2 and FFP3 standard (EN149), that is relevant here. It is clear that a correctly fitted FFP3 should reduce the amount of infectious aerosol released by a measles patient by approximately 99%, surgical masks are more variable, they should reduce the amount of infectious aerosol by approximately 40 to 70%.
If fit is a problem, an FFP2 would be a good compromise. Note that there is no evidence that wearing FFP2/FFP3 causes harm.
To summarise, official NHS guidance says you should try and reduce the infectious aerosol by a measure (a surgical mask) by perhaps 40 to 70% but you “must never” use a measure (FFP3 respirator) to reduce it by 99%. I hope you now can see my confusion. On the face of it this is very strange.
Measles is of course a very dangerous disease.
Could I ask you to pass this on to your colleagues at the Department of Health and Social Care? I would like answers to two questions:
1. What is the justification for this seemingly bizarre guidance?
2. What is the justification for the NHS developing guidance such as this in complete secrecy?
Infection spread in hospitals and other health care settings is a matter of public interest, NHS guidance for it should not be developed in secret.
Thank you, Richard Sear
Chance & Necessity 
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