{"id":47215,"date":"2020-04-17T11:34:00","date_gmt":"2020-04-17T10:34:00","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=47215"},"modified":"2020-04-17T11:43:09","modified_gmt":"2020-04-17T10:43:09","slug":"mike-gill-whitehall-has-locked-down-its-own-capacity-for-flexible-thinking","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/04\/17\/mike-gill-whitehall-has-locked-down-its-own-capacity-for-flexible-thinking\/","title":{"rendered":"Mike Gill: Whitehall has locked down its own capacity for flexible thinking\u00a0"},"content":{"rendered":"

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.<\/span><\/p>\n

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?<\/span><\/p>\n

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\u2019s 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.<\/span><\/p>\n

The Government\u2019s 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\u2019s 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\u2019s 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.<\/span><\/p>\n

Since lockdown, the tone, format, and content of the government\u2019s approach to communication has remained fixed and formulaic. The initial idea of making the daily No. 10 press conference a centrepiece of the government\u2019s 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 \u2018ex cathedra\u2019 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\u00a0 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:<\/span><\/p>\n