The report should be fed into a wider-ranging, but rapid, transparent, review of the UK’s covid-19 preparedness
On 14th July the Academy of Medical Sciences published an impressive report “Preparing for a Challenging Winter 2020/21”, commissioned by the Government Office for Science. The report is authored by some of the finest health scientists in the country and concludes what many now fear: that the country is not prepared for a second wave of covid-19. It is strong on much of what needs to be done, and why. It is less so on how to do it. It sets out a comprehensive list of the systems and actions needed if we are to mitigate effectively the combined effects of winter, a possible flu epidemic, and a resurgence in covid-19. Its recommendations require urgent action across a wide range of issues and by several parties. These include government and its executive agencies, such as Public Health England (PHE), all sections of the NHS, local government, academia, local stakeholders and citizens. It is therefore disappointing that the prime minister appears not to have read it. When asked in prime minister’s questions for a commitment to implement the recommendations, the prime minister not only avoided making any such commitment, but seemed to imply that he thought the recommendations were already being implemented.
The report’s recommendations are based on a careful analysis of the challenges posed by winter, with a strong emphasis on the actions needed to address the disproportionate burden borne by ethnic minority individuals and communities, and the need to co-produce communication materials with local people.
Good though this report is, it is no substitute for the rapid review of the UK”s preparedness that many are calling for. It leaves several key issues unaddressed, including:
- the need to properly manage the interface between health and social care, both strategically and operationally
- the need for clarity of leadership and accountability across the Department for Health and Social Care and PHE
- the public health and other challenges of border management within and between the nations of the UK
- the inadequacy of the processes involved in procurement of goods (eg PPE) and services (eg testing and contact tracing)
- the importance of international collaboration, especially with Brexit looming on 31 December
Nor does the report attempt to set the issues in a wider strategic and policy context, as a rapid review would have to do. It makes a big difference whether the UK’s current and future strategy is to tolerate significant divergence across the four nations. The report’s authors seem to have assumed no overall change to strategy, but they make only very limited reference to the border controls which successful pursuit of zero-covid in Scotland and Northern Ireland may require. Their modelling must therefore include the additional 30 000 deaths predicted by April if England fails to adopt a zero-covid strategy.
The authors may also have underestimated the likely impact of winter. They emphasise the need to increase individual and community resilience by addressing fuel poverty and providing financial support for those forced to lose income in order to self-isolate. But they do not mention the role that austerity has played in the greater number of excess winter deaths over each of the five years up to 2017/8, the years chosen as their baseline for the reasonable worst case, compared with the previous five years. Nor do they reference the continuing growth in child poverty and the use of food banks, including among families with a parent in work. Both are likely to accelerate further as unemployment starts to grip. If the government is serious about increasing resilience, there needs to be an urgent expansion of the safety nets, including Universal Credit. The rapid review would address these issues.
On three key issues the report reaches the right conclusion, but fails to make a clear recommendation to government. First, while it rightly focuses on how to manage the significant backlog of patients needing treatment and care (3.3), it does not address the huge difficulty for people required to self-isolate for 14 days prior to hospital admission. For most people this is just not feasible without financial support to cover loss of earnings. Many will also require accommodation. A clear recommendation to government should be to provide, at a very bare minimum, statutory sick pay, since prior self isolation is now a compulsory and integral part of the “illness episode.”
Secondly, on testing, the report says “Rapid results require widespread, decentralised, and accessible testing options (4.1.3).” This looks like a strong vote against the so-called Pillar 2 centralised testing model, and against its further expansion. This should have been a clear recommendation in bold, if, as it appears, the authors agree with many others that the current centralised model of Pillar 2 testing is flawed. Thirdly, with respect to PPE (18.104.22.168), while they sensibly say the supply chains should be stress tested, there should have been an additional recommendation that the Government examine their whole approach to the procurement of goods and services, which has already been widely criticised, and led to referral to the National Audit Office.
The Academy report goes a long way in setting out what needs to happen quickly to shore up the UK’s resilience before winter comes. It is therefore an important contribution that should be fed into the wider-ranging but rapid, transparent, review of the UK’s covid-19 preparedness that many are calling for. This must result in action, based on a clear strategic plan that works for the UK as a whole. Without this, it will be hard for the government to achieve its stated aim of putting its arms round people and preventing unnecessary suffering and death. Failure to have made adequate preparation in the face of so much detailed advice may be one of the issues requiring scrutiny by the public inquiry, now promised by the prime minister.
Mike Gill, former Regional Director of Public Health, London
I acknowledge valuable assistance from Hilde Rapp, Director of the Centre for International Peacebuilding
Competing interests: None declared