UKHSA and the search for a definition of an “active influenza case”

There is method in our apparent madness. Each Brick builds on the last, following the evidence and narrowing the question: when does detection of influenza viral material become an “active influenza case”? Stay with us as the series continues, and the paper trail unfolds.

Share

In this Brick we report on our numerous exchanges with the Scare Agency. The topic is how the UKHSA distinguishes the detection of influenza virus particles from an active case of influenza. The two documents summarised in this post cover the UKHSA internal review dated 22 July 2026 (IR/240) and its subsequent follow-up FOI answered 21 August 2026 (IR/309).

(Both files are at the bottom of this post for readers’ convenience).

On 28 May 2026 we asked for evidence concerning three related questions:

1. Validation: how PCR detection of influenza had been validated, including against viral culture.

2. Threshold: what Ct value, viral load or infectious dose UKHSA regards as indicating an active influenza case.

3. Definition: what case definitions UKHSA uses for ARI, ILI, “cold and flu,” and—most importantly—influenza itself.

Read more

Of course remuneration is by day/half day for some members and the sums vary according to where the Trust is located but as a rule of thumb a representative acute board might have 6 to 8 executive directors plus 6 to 8 non-executives and a Chair.

Share

NHS England’s published framework currently puts “Non-exec” remuneration at £13,000, with limited £2,000 supplements, while chairs are roughly £49,500–£60,000 depending on turnover. Executive directors are much more expensive: published NHS accounts show that salaries above £150,000 for executive directors are not unusual.

On that basis, an estimated combined cash remuneration of the entire board could readily be £1.5m to £1.9m a year.

There is then the less visible part: a large acute trust might have a company/trust secretary, deputy secretary, governance managers/officers, board administrator, executive assistants and other corporate-governance support. If, illustratively, that amounted to 8 to 12 FTE with an average fully loaded employment cost of £55 to 70k, that gives another £440,000 to £840,000.

Then let’s throw in £100,000 to £300,000 for board recruitment, external governance reviews, training/development, meeting admin, legal/professional advice and other directly attributable expenditure. These are deliberately estimated rather than published NHS averages.

So the sum for the Board and the identifiable governance/support infrastructure is perhaps £2.4m to £3.0m per acute trust per year. Taking the conservative 2.4 million a year we get a cost of £386 million.

Therefore do we need all these boards and costs to run the show?

For example, Tesco’s (the largest supermarket chain in UK) operates thousands of stores, is a huge national organisation and has 336,440 employees, and because it does not require a full corporate board for every substantial geographical cluster of stores, its board cost are much lower: The latest total aggregate remuneration paid to all their directors was £18.6m.

However, our NHS board costs of £386 million is likely an underestimate, as the true costs could be north of half a billion when we factor in several NHS boards are much bigger (Manchester Trust reports 26 directors in office during the year); some folks are on greater salaries than our estimate (Newcastle Trust reports a highest-paid director on £377,500) and our number of trusts in the estimates doesn’t include mental health, community and ambulance/specialist trusts (we make it approximately 205 separate NHS Trust/Foundation Trust Boards in England).

So, why does the NHS need more than a hundred separately constituted acute-provider boards to deliver hospital care in England? What does this governance architecture actually cost—and what justifies such extensive duplication of corporate governance across a single national health service?

Bear in mind, dear readers, that the figures reported here for the NHS (not for Tesco’s) are a vast underestimate of the bureaucratic superstructure taxpayers carry.

This post was written by two old geezers who recognise a good deal when they see one.

Share Trust the Evidence

“What time response do you need?” the ambulance call handler asks.

“Level 2. An 18-minute response,” I reply.

“What’s wrong with the patient?”

“He has urosepsis on a background of myelodysplasia, and needs admission.”

We go through the usual details: Age, address and location.

Then something unusual happens.

“I need to refer you to someone else,” the call handler says.

I wait on the line. A second person answers and introduces himself as a consultant paramedic. He wants to discuss whether the patient really requires the Level 2 response I have requested.

That’s new, I think to myself.

Telephone triage is necessary when nobody has assessed the patient. That is one of the purposes of 999: someone has to establish what has happened, how sick the patient might be and what response is required.

Yet, somewhere between my clinical assessment and the dispatch of an ambulance, another assessment had been inserted. A health care professional who hadn’t seen the patient was now being asked to validate the judgement of the clinician who had.

But I hadn’t called 999.

Share

I had called the dedicated number for healthcare professionals — the route that allows a clinician who has already assessed a patient to request an ambulance response. And this patient had been assessed by me. I had taken the history, examined him, reviewed his medical background and decided that he required urgent admission.

“What is his NEWS2?” I’m asked.

“Four.”

And suddenly, four seems to become the most important fact about the patient.

Except there is a problem: I can’t record his blood pressure because it’s unrecordable.

NEWS2 gives clinicians a common language for describing physiological deterioration. But it isn’t a diagnosis, and it isn’t a replacement for examining a patient.

A NEWS2 of four means one thing in an otherwise healthy person with an infection. It may mean something quite different in a patient with myelodysplasia, suspected sepsis and a blood pressure I cannot even record. The score is the same; the risk is not.

Then there is something NEWS2 cannot know: Myelodysplasia can cause low white blood cell counts, leaving patients vulnerable to serious infections such as sepsis and pneumonia. Infection accounts for up to 1 in 4 deaths in patients with myelodysplasia.

NEWS2 doesn’t know the patient’s neutrophil count, the consequences of their bone-marrow failure, or how dangerous an apparently modest physiological disturbance might be in this particular patient. Unless the health professional on the other end of the telephone knows the patient’s history and understands its significance, neither will they.

Yet here I am, standing beside an acutely unwell patient whom I have examined, explaining to someone who hasn’t seen the patient why the number on the scorecard doesn’t adequately describe the person in front of me.

Previously, the process was straightforward: I assessed the patient, decided they needed hospital admission, explained the clinical problem and requested the appropriate ambulance response.

But all of a sudden, another clinical layer has appeared between my assessment and the ambulance.

Why? Presumably, the answer is demand.

Ambulances need to go to the patients who need them most. But there is an important distinction between triage and re-triage.

There is also something increasingly seductive about healthcare numbers: Scores look objective and reproducible, and they can be entered into boxes, audited, and incorporated into protocols.

However, clinical judgement is messier; it involves experience, pattern recognition, uncertainty and context. It includes noticing that the person in front of you looks considerably sicker than their observations suggest.

What worries me is a system in which clinical validation gradually becomes demand management, in which a numerical score begins to acquire greater authority than the clinician who has seen the patient.

There is a particular irony in using NEWS2 this way. The score exists to help us recognise the deteriorating patient; it should not become a reason for failing to recognise one.

There is a brief pause.

“Oh, that’ll be a Level 2 response then,” he says.

“I’ll hand you back to the call handler.”

And on I go.

Trust but verify (traditional Russian proverb)

Readers will recall that when NHS England announced the rollout of AI triage through the NHS App in July, the press release rested on a single compelling statistic: an “initial trial” at a general practice in Sussex had produced a 29% reduction in the number of people queuing on the phone. The figure was repeated widely in the media and presented as evidence that AI could help solve the notorious 8 a.m. scramble for GP appointments.

Share

When we investigated the claim, however, we discovered that the published preprint describing the Sussex pilot contained no analysis of telephone queue volumes. NHS England told us that the 29% figure did not come from the published study at all, but from an unpublished internal evaluation based on GP telephone data.

The TOGs asked the Office for Statistics Regulation (OSR) to consider whether this met the standards expected of public bodies when using statistics to support policy.

The OSR has now replied and upheld our concerns over NHS England’s use of a headline statistic to justify the national rollout of AI triage.

Its conclusion could hardly be clearer.

“We have found that NHS England’s statement about the GP practice trial did not meet our expectations under the Code of Practice’s Standards for the Public Use of Statistics, Data and Wider Analysis.”

The issue was whether NHS England should have used a striking numerical claim to support a major national policy announcement before publishing the evidence for it.

The regulator’s answer is no.

The OSR points to Standard 1: Equality of Access, which requires public bodies to make the statistics, data and wider analysis underpinning public statements available in a timely manner. As the regulator explains:

“Public statements that report data should draw on published sources, such as by ensuring that any unpublished data is published ahead of or in parallel with any public statement.”

It then delivers its central finding:

“The use of the 29% figure in this NHS England statement does not align with these expectations.”

This ruling is important because it reminds the government that it should not use unpublished analyses to persuade the public of the benefits of a major policy without making those analyses available for scrutiny.

The regulator also says it has already raised the matter with NHS England. According to the OSR, NHS England has committed to publishing a supplementary release containing the data underpinning the claim, together with its provenance, methodology and relevant caveats, and to improving internal compliance with the standards governing the public use of statistics.

Our TTE investigation raises a larger question” If it took independent scrutiny—and intervention by the UK’s statistics watchdog—to secure publication of the evidence behind a headline claim used to justify national policy, how many other “miracle statistics” are circulating without the supporting analysis ever seeing the light of day?

Re Request For Review Of Nhs England's Use Of An Unpublished Statistical Claim In Support Of National Ai Policy

115KB ∙ PDF file

Download

Download

The story was reported in GB News by Lucy Johnston.

This post was written by two old geezers who made the elementary mistake of assuming that a headline statistic in an NHS England press release would be accompanied by the evidence on which it was based. That’s the way it used to be, but that was a long time ago.

The curious disappearance of the NHS’s ‘evidence-based’ winter plan

Three years ago, NHS England appeared to know what hospitals needed to do to survive winter. Its 2023/24 Winter Plan contained ten “High-Impact Interventions”. They included Same Day Emergency Care, acute frailty services, better inpatient flow, improved community-bed productivity, Care Transfer Hubs, intermediate-care planning, virtual wards, Urgent Community Response, a Single Point of Access and Acute Respiratory Infection hubs.

Share

NHS England referred to them as “evidence-based and clinically supported actions” which every system would be asked to deliver and provide assurance against.

In 2022, NHS England had already promoted virtual wards, community falls services and ARI hubs, saying the measures had been co-created with clinical and system leaders and selected because the evidence suggested they would have the greatest additional impact. Then came the ten, and, at least initially, NHS England thought things were working.

Its review of 2023/24 reported the first year-on-year improvement in four-hour A&E performance in a non-pandemic year since 2009/10. Category 2 ambulance responses improved by around 14 minutes; around 500 fewer patients each day remained overnight due to delayed discharge, and Urgent Community Response treated 720,000 people outside hospital, while virtual wards supported more than 240,000.

In May 2024 NHS England therefore said there would be a “continuing focus” on the ten high-impact areas.

It had, it said, learned from systems, providers and the “early findings of formal evaluation”.

However, two years later the ten have disappeared.

Read more

The wizards of Oz.

We continue with our observations and inquiries on what is going on Down Under, this time in Australia.

Share

We told our readers that we would keep an eye on Oz and Kiwiland, and so we have. Badly infected with the TOG virus ourselves—we are both PCR-positive, with cycle thresholds hovering stubbornly around 10 and a typical clinical history—we also asked some Oz bodies what, exactly, they mean by an active case of influenza.

New South Wales

In Brick 8a, we made the connection between the scary winter Down Under and the winter crisis that followed, which became rather clearer with last year’s nonsensical “Superflu” story.

The latest news from New South Wales (NSW) is not encouraging: “Influenza activity increased and is now at a high level of activity.”

Well, by Jove, how can that be? NSW’s own influenza vaccination targets are considerably higher for two particularly vulnerable groups: 40% for children under 5 and 75% for those aged over 65.

Yet the NSW surveillance data backs up the story: influenza activity is high and rising—although, on the face of it, the increase looks remarkably similar to last year’s.

Emergency department presentations and admissions for influenza-like illness are increasing, particularly among children under 10. However, the absolute number of admissions remains small.

So, we asked the NSW Ministry of Health the usual two questions:

Would you please provide me with:
Q1. Your definition of an active case of influenza.
Q2. The methods used to confirm an influenza case and distinguish it from other acute viral respiratory infections.

We got a reply:

Read more

Read more

Will we have “Rocket flu” this year?

In Brick 8a, we made the connection between the scary winter Down Under and the winter crisis that followed. That connection became rather clearer with last year’s nonsensical “Superflu” story.

In Brick 5.7, we explained that we had been investigating what public health bodies actually mean by the terms “influenza” and “active infection”.

So, what’s happening in Kiwiland? The answer appears to be: much the usual for this time of year.

But now we have a new space-travel term to keep an eye on. Will it make an appearance at this end of the world when the time comes?

Read more

7.27 million

The number of cases currently sitting on England’s elective treatment waiting list at the end of June 2026. Behind it are around 6.15 million people waiting for care.

A number the mainstre…

Read more

A little more information about the expenditure by xxxxxxx has just been unearthed by Hawkeye.

We are not quite sure where it fits within the rather conservative £43-odd million that UKHSA spent in Ju…

Read more

We start with Lassa Fever, an …

Read more

Share

Our readers may be interested in the latest (partial) disclosure: the UKHSA Advisory Board: register of interests

Here are the names and disclosures, all updated to May-July 2026, as reported in the Gov.uk document:

Iain Peters, Chair -

Chair NHS London Region

Director and 50% equity shareholder in Clef House Limited

Felicity Cooper –

Associate Non-executive

Non-Executive Director, Royal National Orthopaedic Hospital NHS Trust

Stuart Dollow –

Non-executive member

50% shareholder of Vermilion Life Sciences Ltd

Occupational pension schemes with Roche and GSK Date of declaration 26 June 2026

Jon Friedland – Non-executive member

Prof City St. George’s, University of London

President – European Society of Clinical Microbiology and Infectious Diseases

Marie Gabriel - Associate non-executive member

Chair of NHS North-East London Integrated Care Board

Graham Hart - Non-executive member

Professor, University College London

Chair, Medical Research Council Applied Global Health Research Board

Susan Hopkins – Chief Executive

Consultant in Infectious Diseases and Microbiology, Royal Free London NHS Foundation Trust

Professor of Infectious Diseases and Health Security, University College London

Research associations with UCL, Imperial and Oxford University related to grants and teaching

Sarah Jensen - Associate non-executive member

Chief, Digital and Infrastructure Officer at Cambridge University Hospitals NHS Foundation Trust

Robin May – Chief Scientific Officer, seconded from University of Birmingham

Steven Riley – Chief Data Officer, seconded from Imperial College London.

A very interesting and prestigious set of names and institutions, no doubt. Before we go any further, though, we noticed something missing at the bottom of the declaration.

Read more

The answer is no. What’s the question, please?

A few days ago, we reported our inquiry into how much the UKHSA had spent on the three cornerstone vaccines of the Winter Crisis: Influenza, Covid, and R…

Read more

Old geezers do read newspapers, still. That’s the way we were dragged up, and ol…

Read more

We usually start at the football pages, but this caught our eye in The Times.

We cannot reproduce the article because of obvious copyright reasons, but the subtitle provides a pretty good summary.

Share

Six years after the catastrophic mismanagement of the circulation of a then newly identified viral threat, we are apparently discovering the wreckage that incompetent governments, fake advisors, profiteers and the WHO left behind.

The two old geezers agree entirely, wholeheartedly, happily - well, sort of.

There is just one problem. It’s all a bit too late.

Not only is it too late, but the lessons have not been learned, as instead of asking critical questions and holding those responsible accountable, we have the Hallett Inquiry and the WHO trying to bind democratically elected governments to its perception of future “pandemics” or international incidents or whatever they want to call it.

WHO claims no responsibility, but Test, Test, Test and its irresponsible elevation of PCR to gold standard fuelled the panic. Narcissists, money launderers and authoritarians did the rest.

DONATE to keep TTE going

So, Ms Yu, these two old dodders opened their “it’s too awful to remember” locker and several questions sprang out.

Read more

Then Fauci chipped in and said he’d asked around.

He returned with a more specific concern: The inflammatory response and fever experienced by some people following the second vaccine dose, he wrote, “theoretically could be associated with miscarriage in the 1st trimester.”

Walensky replied: “Definitely a good point, esp after dose two.”

Share

Yet, within days, Fauci was discussing vaccination in pregnancy publicly. On the 3rd of February, he said approximately 10,000 pregnant women had been vaccinated and that there were “no red flags”. But he also qualified it with “we don’t have good data on it.”

Read more

An update on the TTE FOI requests

We recently summarised the themes or threads of our inquiry into the evidentiary basis of the “winter crisis”.

The third thread or theme examined influenza and active infection and we explained the rationale as follows:

“People use the word “flu” to describe almost any unpleasant respiratory illness. Clinically, influenza means something much more specific; yet even laboratory confirmation raises further questions. A positive PCR test demonstrates that influenza RNA is present in the specimen; it does not automatically prove active infection, active viral replication, or clinical illness.”

A simple analogy is: PCR is like finding fingerprints at a scene, which show that someone was there, but they don’t necessarily tell you exactly when they were there, what they were doing, or whether they caused what happened.

Share

“After months of correspondence and an internal review, the UKHSA confirmed precisely that distinction. Clinical interpretation depends upon viral load, specimen quality, timing of sampling and the patient’s presentation. In other words, a laboratory result requires clinical context before conclusions can be drawn.

That clarification matters because surveillance statistics, modelling and planning all begin with case definitions. If the definition at the beginning of the chain remains uncertain, uncertainty inevitably travels through everything built upon it.”

Think of it like building a house using a measuring tape that may be slightly inaccurate. One measurement being a little off might not seem important. But you use that measurement to position the walls, then use the walls to position the roof, windows and doors. The further you build, the more consequential that original uncertainty becomes.

To put it simply, if you’re not completely sure what you’re counting at the beginning, you can’t be completely sure what the resulting total represents.

In Brick 5.7

we explained how we were investigating the public health use and meaning of the word “influenza” and “active infection”.

People use the word “flu” to describe almost any unpleasant respiratory illness. Clinically, influenza means something much more specific; yet even laboratory confirmation raises further questions.

Think of it like detecting smoke tells you smoke is present, but not whether there is an active fire or what caused it. Likewise, PCR detects viral genetic material; it does not, by itself, establish active infection or the cause of illness.

So, after months of correspondence and an internal review, the UKHSA confirmed precisely that distinction.

Clinical interpretation depends on viral load, specimen quality, sampling timing, and the patient’s presentation. In other words, a laboratory result requires clinical context before conclusions can be drawn.

That clarification matters because surveillance statistics, modelling and policy all begin with case definitions. If the definition at the beginning of the chain remains uncertain, uncertainty inevitably travels through everything built upon it.

In 5.7, we reported asking two simple questions to Trusts and Boards around the United Kingdom:

As you know, the Scare Agency appears remarkably willing to treat a positive influenza PCR as evidence of infection, never mind questions about contamination, residual viral RNA, or whether the detected material represents an active infection. But then, there is a reason we call them the Scare Agency.

Read more

Share Trust the Evidence

The first of the newly released text exchanges concerning Anthony Fauci and other senior US health officials raises a question that should be familiar to anyone interested in evidence-based medicine:…

Read more

On 29 July, the former director of the National Institute of Allergy and Infectious Diseases appeared under subpoena before the Senate Homeland Security and Governmental Affairs Committee. Asked about the origins of Covid, research funded in Wuhan and his previous statements to Congress, Fauci repeatedly invoked the Fifth Amendment. More than 100 times, by some counts.

Senators soon tested the limits of this strategy. Josh Hawley asked Fauci what day it was and the colour of his tie; Rand Paul asked whether the red folder sitting in front of him was, indeed, red. Fauci declined to answer; it made for irresistible television, but the colour of Fauci’s tie is not the story.

Share Trust the Evidence

The Fifth Amendment privilege exists precisely because witnesses should not be compelled to provide evidence that could be used against them. Fauci’s lawyers maintain that he faced potential legal jeopardy despite Joe Biden’s pre-emptive pardon; the committee chairman disputed that interpretation, an argument that may now be fought out elsewhere.

The more interesting question, though, is why congressional investigators wanted Fauci answering questions under oath in the first place.

Consider how much has emerged since the early months of 2020.

Read more

Some weird stuff from the Scare Agency, and the two old geezers are not quite sure what to make of it. Here we go.

Share

Preparations for the Winter Crisis are now up and running in earnest. No, it’s not too early.

For example, the Scare Agency keeps us updated every month on the level of coverage of RSV vaccination (including for example training slides sets) while in Brick 1 we reported on the generous offer of free influenza vaccination for the homeless — in June.

So, given that the Scare Agency kindly lets us know whenever it spends more than £25,000, we thought we’d ask how much it had spent on the three cornerstone vaccines of the Winter Crisis: Influenza, Covid and RSV.

We also planned to repeat the FOI request periodically, so we could keep track of the mounting cost of averting the Winter Crisis, or not averting it, as the case may be.

And this is where things get a little weird.

Here is the FOI exchange, started on 31 July, which you can read and follow the correspondence on WhatDoTheyKnow, or read our summary below:

Freedom of Information request

Subject: Breakdown of vaccine expenditure by target viral agent

Dear UK Health Security Agency, in your June Spend over GBP 25,000 report you provide a breakdown of expenditure by item. One line item is:

Vaccines & immunisation (MSD, Seqirus, GSK, Pfizer, Sanofi)

£45.07m

Would you please provide me with a breakdown of expenditure by the following vaccine target agents:

Influenza

SARS-CoV-2

RSV

To clarify, I am not interested in a breakdown by manufacturer, only by target agent.

Yours faithfully.

The hyperlinked sheet did not specify by line which vaccines they were spending money on, just the generic entry “vaccines” and the total by manufacturer.

We got an answer, or rather a request for clarification, which floored us as we fell off our wheelchairs:

Dear [Old geezers]

We would be grateful if you could identify the line item:

Vaccines & immunisation (MSD, Seqirus, GSK, Pfizer, Sanofi) £45.07m in the

attached spreadsheet.

Yours sincerely,

The emphasis is ours.

Yes, you read that correctly. The Scare agents were asking us to identify the relevant line in their own spreadsheet.

Once we had been lifted off the floor and back into our wheelchairs — a manoeuvre requiring the assistance of half a dozen people — we wrote back on 4 August.

Read more