Chris Ham: Dithering and delays hampered the UK’s covid-19 response

A major report from a year-long joint inquiry by the House of Commons Health and Social Care Committee and Science and Technology Committee offers a forensic analysis of six aspects of the government’s response to covid. Drawing on a treasure trove of evidence from over 50 witnesses and over 400 written submissions, the committees provide a valuable assessment while leaving scope for further analysis of some key questions they do not explore.

The report is most forceful in its criticism of the delay in responding to the pandemic in March 2020. Describing the government’s approach as “fatalistic,” it argues that there was a consensus between official scientific advisers on SAGE and the government amounting to groupthink on what should be done. This involved trying to manage the spread of covid through the population rather than acting to stop it altogether by following the lead of many east and south east Asian countries.

The report argues that groupthink could have been avoided if ministers and other advisers had challenged the advice given by SAGE. They were reluctant to do so in the face of a consensus developed by official scientific advisers and this only changed when the likely impact on the NHS became clear. The committees conclude that in future government and SAGE should facilitate external and structured challenge to scientific advice, including from other countries and a wider range of disciplines. 

The committees are almost as forceful in their assessment of the shortcomings of the test, trace, and isolate programme, the mishandling of social care, and the impact on at risk communities. In each case they set out clearly the choices made by government and the opportunities missed along the way. They also criticise the UK’s preparedness, based as it was on the risk of an influenza rather than a SARS pandemic, and complex and confusing communications with the public after the initial stages. 

More positively, and rightly, the report praises the development of vaccines, the delivery of the vaccination programme, and the assessment of treatments in the Recovery trial. The constructive contribution of the MHRA and the JCVI is also acknowledged. The work of the armed forces in the response, including on the testing and vaccination programmes, leads to a recommendation that they should have a standing role in preparing for and responding to emergencies like pandemics.

The report also recommends that the success of the vaccine task force should be replicated in other areas of public policy. This means bringing in teams of outside experts to work alongside ministers and civil servants with the scope for making decisions at risk, outside conventional procurement procedures.

The main purpose of the inquiry was to learn lessons for the future. The way in which the government was organised is the focus of many of these lessons and neither COBRA nor the Civil Contingencies Secretariat in the Cabinet Office come out well. The committees recommend that the secretariat should be empowered to stress test emergency plans in government departments and should have the resources and capabilities to do so effectively.

In an otherwise comprehensive review, there are two significant omissions in the report. The first concerns the role of the devolved administrations, elected mayors, and local authorities. The UK’s response was among the most centralised in the world and little effort was made to seek the views of leaders in other home countries nor those in local government in England. Better decisions would almost certainly had been made if this had happened, and if leaders in Whitehall had sought the expertise of those at the forefront of the response in care homes, schools, and public health teams.

The second and bigger omission concerns the role of the prime minister who was slow to recognise the seriousness of covid and did not attend a meeting of COBRA until 2 March. The prime minister’s absence matters because Boris Johnson was the dominant figure in the government having won a sizeable majority at the December 2019 general election and taken the UK out of the EU on 31 January 2020. As other accounts have shown, he was preoccupied with Brexit and personal issues in the early stages of the pandemic and his absence from key meetings contributed to the lack of challenge to official scientific advice highlighted by the committees.

When the prime minister did choose to engage it took time for him to understand the implications of what was happening and to be persuaded to act decisively. His concern throughout the pandemic was that the damage to the economy from lockdowns would be greater than the damage to health of not locking down and he was instinctively opposed to constraining people’s liberties. The dithering and delays that resulted were arguably as consequential as the groupthink criticised in the committees’ report.

The prime minister’s chief adviser, Dominic Cummings, explained in his evidence to the inquiry that the prime minister preferred to work in a chaotic environment because this meant that people would look to him “to see who is in charge.” Chaos helps explain why there was no coherent strategy to guide the pandemic response supported by credible implementation plans. This resulted in avoidable errors that led to a steep decline in economic performance alongside high death rates.

It will be for others to fill these gaps ahead of a full public inquiry. For now, the committees have laid out clearly and convincingly the strengths and mainly the weaknesses of the government’s response based on the evidence of some of those who were in the room where it happened and others who worked with them.

Chris Ham is chair of the Coventry and Warwickshire Integrated Care System, Co-Chair of the NHS Assembly and non-executive director of the Royal Free London Hospitals NHS Foundation Trust. He gave evidence to the inquiry and writes here in a personal capacity.

Competing interests: none further declared.