Restoring the collective action that existed at the start of the pandemic is an urgent priority, argues Chris Ham

Cracks in the already fractured national consensus on how best to respond to covid-19 grew wider and deeper this past week as the forces of science, politics, and economics combined to pile pressure on the government.

Publication of the minutes of the SAGE meeting held on 21 September revealed major differences between its recommendations on slowing the increase in infections and the actions taken by the government. The package of interventions outlined by SAGE, including a short national lockdown or “circuit breaker” to return incidence to low levels, went much further than the measures announced by the Prime Minister Boris Johnson after the meeting. The government’s own scientific advisers made it clear that these measures were unlikely to be sufficient, opening up a wide gap between the “science” and government policy.

This gap was exploited by the leader of the opposition, Labour’s Keir Starmer, who called on the government to adopt a circuit breaker as soon as possible. While not ruling out doing so, the Prime Minister instead announced three tiers of restrictions based on whether the rate of infections was medium, high, or very high. He argued that increasing restrictions in areas of the country most affected—and asking the public to comply with advice on social distancing, wearing face coverings, and washing hands—were preferable to a second national lockdown and the disruption this would cause, not least in areas with low rates of infection. 

In resisting calls for a national lockdown, the Prime Minister was supported by many members of his own party who expressed concern about the damage to the economy and the infringement of personal liberty that would result. Leaders from those parts of the economy most affected, such as the hospitality industry, added their voices to the chorus of concern, pointing to the risks of substantial job losses if pubs and restaurants were required to close again. Their views were shared by local government leaders from across the political spectrum who called on the government to provide more financial support to businesses where restrictions were tightened.

The public standoff between the government and local government leaders across Greater Manchester on the government’s proposal that the region should move from high to very high restrictions symbolised these stark differences on how to respond to the resurgence of covid-19. The support of MPs from all parties in the region for the stance taken by local government leaders added to the difficulties facing the government. It also increased the pressure on ministers to offer more generous financial support to areas affected by the most stringent restrictions, as agreed in the case of Lancashire and retrospectively the Liverpool City Region.

The fracturing of the national consensus in England was underlined by the divergent paths taken by the devolved administrations in Northern Ireland, Scotland, and Wales and the willingness of their leaders to criticise the UK government for not involving them adequately in decision making. Circuit breakers seem likely to be adopted in each of these countries, as well as tighter restrictions on travel from areas with high rates of infections and the more generous provision of free school meals.

One way of resolving these disagreements would be for the Prime Minister to adopt a more inclusive approach by inviting the leader of the opposition and regional mayors to join him and the first ministers of the devolved administrations in deciding how to respond to SAGE’s advice. The meetings would only be effective if they took place frequently and the Prime Minister, his ministers, and advisers engaged seriously with them. This could be done either through COBRA or an emergency committee established specifically for this purpose.

One of the attractions for the Prime Minister of a cross party approach embracing all four countries in the UK and local leaders in England is that it might help restore the public’s confidence in the government’s handling of the pandemic. Surveys show that confidence fell sharply in England between March and September in contrast to Scotland and Wales where it increased. Researchers attributed the decline to the government’s mismanagement of the pandemic and the decision of the Prime Minister’s adviser Dominic Cummings to travel with his family to Durham in contradiction to the restrictions in place at the time. 

A cross party approach could also help rebuild public trust and compliance with the measures needed to break chains of transmission. In a society uncomfortable with authoritarian measures of the kind deployed in some countries, it is an admission of failure to rely on legal enforcement and fines as the principal means of controlling outbreaks. Far better to engage people and communities in what needs to be done, recognising that nobody is safe until everybody is safe, and that we all have a duty to slow the spread of the virus. Restoring the commitment to collective action that existed in the early stages of the pandemic is now an urgent priority.

A more broadly based COBRA membership would have the added advantage of avoiding a London-centric bias in decision making. This bias was evident in the decision to ease the national lockdown in May when infection rates had fallen in the south of England but remained high in the north. The pressures now being experienced in Greater Manchester, the Liverpool City region, and the North East are almost certainly a legacy of this decision and the lack of diversity among those directing the response to covid-19.

The wider lesson is the need to change the relationship between central and local government. Further devolution of powers to regional mayors and local authorities would enable decisions on local restrictions, test and trace, and other interventions to be taken by leaders who understand the populations they serve. The mismanagement of the pandemic demands a constitutional reset to ensure that central government can never again fail on the scale seen in the response to covid-19.

For now, reshaping the governance of the pandemic through a cross party approach would be a small step in the right direction. To borrow from W B Yeats, the centre may not be able to hold but it is not inevitable that “mere anarchy is loosed upon the world” if political leaders understand that sharing power is a sign of strength and not weakness. 

Chris Ham is non-executive chair of the Coventry and Warwickshire STP and non-executive director of the Royal Free London Hospitals. He was chief executive of the King’s Fund from 2010 to 2018.

Competing interests: I have read and understood BMJ policy on declaration of interests and declare that I receive remuneration from the NHS as chair of the Coventry and Warwickshire Health and Care Partnership, co-chair of the NHS Assembly, and non-executive director of the Royal Free London Hospitals NHS Foundation Trust. I am the former chief executive of the King’s Fund.