We are all in lockdown, but covid-19 seems to have been the spur to all sorts of imaginative behaviours on the ground. For example, NHS care delivery has been redesigned at a pace unimaginable in more stable times. Everywhere, volunteering is showing what it can do in the age of social media. In contrast those in and around Whitehall are responding poorly. Effective crisis management demands flexibility and collaboration. We are seeing neither.
The proper strategic design and successful execution of emergency plans require at least three things, evidence-based policy development, clear communication of political judgment and decisions, and engagement of civil society. They are intimately interdependent. How is Whitehall doing?
As we approach the fifth week of lockdown, the focus has shifted from “how do we control or reduce the spread of this pandemic?” to a very different sort of challenge “how we come out of lockdown safely, with maximum preservation of life, but minimum destruction of the county’s economy and social fabric?” We might now expect visible adjustments in the approach Whitehall is taking to all three of the emergency plan components. We are not.
The Government’s main source of evidence-based policy development has been the Scientific Advisory Group for Emergencies (SAGE). Its composition is supposed to reflect the nature of the emergency. Its output to date reflects the professional focus of its members and expert groups, dominated by infectious disease modellers and behavioural scientists, and the questions they were appropriately asked some weeks and months ago. SAGE’s membership is not revealed during an emergency, but from what little we know, now needs urgently to change. There needs to be a fundamental reframing of the questions on which scientific and other advice is now sought. The complexities thrown up by the question “How best to lift lockdown?” are not only, or even primarily, epidemiological. For example questions about the potential contribution of modernised approaches to contact tracing, e.g. mobile app-based, are in part technical, in part sociological and geographical, and crucially in part ethical. The development and imminent launch of a mobile-based contact tracing app announced on Easter Sunday by the secretary of state for health Matt Hancock has not, as far as we know, been preceded by any adjustment of SAGE’s membership and focus. The announcement on Friday morning of the involvement of a group of scientists working under the auspices of the Royal Society to address a range of issues is clearly welcome, however late.
Since lockdown, the tone, format, and content of the government’s approach to communication has remained fixed and formulaic. The initial idea of making the daily No. 10 press conference a centrepiece of the government’s communication strategy made sense in the early days of lockdown. Many commented favourably on the optics of the prime minister enunciating government policy with senior experts on each side. Now the seven or eight word mantra on the front of three wooden lecterns and the ‘ex cathedra’ format of the occasion make it come across as itself wooden and constraining. What is said is often perceived to be patronising and repetitive, sometimes evasive (although this certainly does not apply to all participants, and there has been some overall improvement in recent days). The mental tramlines created by the format are reflected in the repetitive nature of the questions from the press. It is almost as if their own thinking has become constrained. Understandably the focus persists on some of the huge operational challenges such as personal protective equipment and ventilator shortages, and testing availability, precisely because they have yet to be sorted, itself a scandal. But other key questions that we should now be addressing are not asked. They include:
- Why are you continuing to treat the population as objects?
- Why are you talking to the public as if the only way they can be actively engaged is by agreeing to be passive?
- What will be the government’s approach to engaging the public in genuine discussion about how to respond to the trade-offs. Such as trade-offs between effective contact tracing and infringements of civil liberties, or between ensuring personal safety and opening up the economy?
- What steps is the government taking which will reassure people that food supply really is going to remain secure?
- What steps are being taken now to build up the significant local resource required for effective case identification, contact tracing, quarantining, and managed isolation on the scale needed to minimise the risk of a second and further waves, once lockdown begins to be eased?
Compliance with the lockdown by the British public looks increasingly unfeasible as long as the tone of the message remains as “headmasterly.” Constant reference to “reliance on the science” feels meaningless, given the breadth of issues now confronting us. As political behaviour, it begins to smack of blame diffusion. Refusal to apologise for shortages of personal protective equipment is indefensible.
By way of involving civil society, the appeal for volunteers was successful and a good start. We now need to go much further. We need rapid development of an effective community engagement strategy. This should be based on a broader set of disciplines than have formed the basis of the Government’s scientific advice so far. It should have as its goals that
- The public understand, have confidence in, feel ownership of, and will actively participate in any of the steps required to exit lockdown, even if this is at the cost of a temporary loss of personal privacy
- Social entrepreneurship is further stimulated, especially at very local levels, to minimise the deleterious effects of lockdown and its sequelae on individuals, families, and communities
The methods may include the encouragement of local leaders, both formal and informal, to establish forums, presumably e-forums, for local discussion of the key issues as they emerge. The role of local leaders needs boosting, including business and faith leaders, as well as those within local government, and specifically of directors of public health. The role of local public health teams needs reasserting, including environmental health officers, apparently for some reason never involved in the early contact tracing. These teams are vital to our being able to exit lockdown. They need very active and urgent rebuilding.
Many of the key issues could be presented at a national level as issues for rapid consultation, promulgated in short and accessible formats. SAGE’s expertise might be expanded to assist in the rapid gathering and structuring of the evidence and ethical frameworks to assist in the production of these “consultation briefings.” Communications experts should be drafted in to help design them.
Instead we are about to be presented with further potential erosion of our civil liberties through the introduction of a mobile-phone app without as yet any proper parliamentary scrutiny, let alone public discussion, of its implications.
While the lockdown persists, there is now a unique window of opportunity to make policy development much more inclusive and comprehensive. Unless this is seized, the British public’s attitudes and behaviour, not to mention mental health, are likely to change for the worse. The current peace, based as it is at least partly on fear, feels fragile, despite the recent poll data showing strong support for lockdown extension. Unless Whitehall now takes active steps which can be perceived by the general public as engendering trust, enabling and empowering, and not as further directives, it may well become more fragile.
Mike Gill, former Regional Director of Public Health, South East England.
Competing interests: None declared.