{"id":50331,"date":"2021-05-26T17:44:29","date_gmt":"2021-05-26T16:44:29","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=50331"},"modified":"2021-07-30T14:32:53","modified_gmt":"2021-07-30T13:32:53","slug":"martin-mckee-what-did-we-learn-from-dominic-cummings-evidence-to-mps-on-the-covid-crisis","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/05\/26\/martin-mckee-what-did-we-learn-from-dominic-cummings-evidence-to-mps-on-the-covid-crisis\/","title":{"rendered":"Martin McKee: What did we learn from Dominic Cummings’ evidence to MPs on the covid crisis?"},"content":{"rendered":"

Cummings\u2019 evidence portrays a system that is not fit for purpose and goes some way to explaining why the UK\u2019s performance on covid-19 was so poor<\/p>\n

<\/p>\n

Now that Boris Johnson, the UK prime minister has kicked the promised official inquiry into the UK\u2019s covid-19 response<\/span> into the long grass<\/span><\/a>, those of us who desperately want to know what went wrong must rely on any crumbs of information we can find. Consequently, as judged by the flow of comments on Twitter, almost everyone that had taken an interest in the events of 2020 in the UK was glued to the broadcast of Dominic Cumming\u2019s appearance before a joint hearing by the House of Commons<\/span> Science and Technology Committee<\/span><\/a> and<\/span> Health and Social Care Committee<\/span><\/a>. And we were rewarded with a veritable feast.<\/span><\/p>\n

The revelations will keep scholars and commentators busy for weeks. Cummings was recounting his recollection of events, albeit one that seemed to be backed up by detailed records (although 10 Downing Street had refused him permission to confirm events in his official diary and emails). Those involved will have their own recollections and, given the extremely serious allegations of incompetence and dishonesty, made under parliamentary privilege, some caution is required until those accused have had the right of reply. Matt Hancock <\/span>has already rejected<\/span><\/a> all claims that Cummings has made against him. However, Cummings\u2019 evidence does shed light on what happened at certain critical periods. Did the prime minister really propose that people might try to become infected with the equivalent of chickenpox parties, even doing so on live television? Did Matt Hancock, the health secretary, really tell his cabinet colleagues that those patients being discharged from hospitals to care homes were being tested when they were not? Was the health secretary intervening in the scale up of the testing system, including holding back tests, to enable him to announce on television that he had hit his target of 100,000 tests per day? Matt Hancock will answer an urgent question in front of MPs tomorrow, and chair a Downing Street press conference so he can expect some difficult questions.\u00a0<\/span><\/p>\n

While waiting for these issues to be resolved, there are already some lessons that could be learned. Unfortunately, it is unlikely that they will be. While some of the evidence was jaw dropping, mainly because of the candour with which Cummings spoke about some politicians, many of the things he said were long suspected even if officially denied. Herd immunity was a core element of the government\u2019s policy. The economy was prioritised over health. The prime minister was not following the science, but rather was behaving like \u201ca shopping trolley smashing from one side of the aisle to the other\u201d, propelled in part by Daily Telegraph editorials. However, what is most important are the governance problems he described. Taken together, they portray a system that is not fit for purpose and go some way to explaining why the UK\u2019s performance was so poor. The first relates to transparency. Cummings described a bizarre paradoxical situation. In theory, key decisions should be made at COBRA meetings (named after the Cabinet Office Briefing Room A where they are held). These meetings are secret. The room is swept for bugs and all laptops and communication devices must be left outside. This makes it impossible for analysts to answer detailed questions that require access to data. Yet despite these efforts to maintain secrecy, the meetings \u201cleaked like a sieve\u201d, with the media hearing about what was discussed almost in real time. As a consequence, the meetings were, it seems, completely dysfunctional, consisting mainly of anodyne Powerpoint presentations.\u00a0<\/span><\/p>\n

The prime minister has been criticised for failing to attend the first five COBRA meetings, and there is no doubt from other accounts that he had many other preoccupations in his political and personal affairs, but from Cummings\u2019 account it is not obvious that the prime minister would have added anything had he been present. Indeed, the descriptions of how he constantly changed his mind make one wonder whether he could have made the necessary decisions anyway.\u00a0<\/span><\/p>\n

While the case for confidentiality can be made for COBRA decisions, this is not the case with the scientific advice to government, channelled mainly via the Scientific Advisory Group on Emergencies (SAGE). At first this advice was a closely guarded secret. Indeed, even the names of those giving advice were secret. Cummings\u2019 account suggests that this was a big mistake. There was classic groupthink, with essentially two options being considered, either letting infections rip through the population to produce herd immunity in time for the winter when the NHS would be facing its usual seasonal pressures, or \u201csquashing the curve\u201d, to avoid the NHS becoming overwhelmed. Other approaches, adopted by countries that, as we now know, have been far more successful, were rejected out of hand. It was assumed that the British public simply would not accept the sorts of restrictions being imposed elsewhere, especially in East Asia. Cummings described how he sought advice from two leading mathematicians who challenged these views and SAGE was eventually opened up to scrutiny, a decision supported by the members of SAGE and by Patrick Vallance, the government\u2019s Chief Scientific Adviser.\u00a0<\/span><\/p>\n

A second relates to government capacity. Cummings described a crucial day when key covid decisions were being made, but the machinery of government was being diverted by a request from President Trump to bomb targets in the Middle East and the insistence, by the prime minister\u2019s fianc\u00e9e, that the Number 10 press office should respond to a newspaper story about their dog. Of course, as<\/span> Harold Macmillan<\/span><\/a> famously said, what kept him awake at night were \u201cevents, dear boy, events\u201d and the coincidence of three such important events would always be difficult to handle, but at least one of them might, arguably, have been put to one side. However, the more important picture to emerge, to use Cummings\u2019 words, is that the business of government was undertaken by \u201clions led by donkeys.\u201d\u00a0<\/span><\/p>\n

Cummings related many accounts of junior staff doing remarkable things in record time. But he also described examples of monumental incompetence. As many suspected, Cummings confirmed that there was no plan for the pandemic, although he alleges that he was reassured by Matt Hancock early on that there was one. Indeed, it appears that there were not even any plans to dispose of the bodies of those who might die. Nor was there any plan for emergency procurement, which may explain the debacle that ensued, and which Cummings gave more examples of. Alarmingly, it seems that the government still lacks up to date plans for many important risks, with solar flares, which can knock out satellites, and anthrax offered as two examples.\u00a0<\/span><\/p>\n

The weaknesses of the British system of government are well known, even if many in the political class are in denial. Many were captured in a 2013 book<\/span> The blunders of our governments<\/span><\/i><\/a> and it seems that little has changed. Indeed, it may have got worse. One quote from Cummings\u2019 evidence stands out: \u201cThe political system is not set up to deal with a secretary of state who repeatedly lies.\u201d But maybe this raises wider questions about all ministers, even<\/span> those at the very top<\/span><\/a>. However, the chances of doing anything about it seem remote. As Cummings said \u201cThe British state is set up almost by design to create a dysfunctional system.\u201d\u00a0<\/span><\/p>\n

Martin McKee<\/i><\/b>, Professor of European Public Health, London School of Hygiene & Tropical Medicine.\u00a0<\/span><\/i><\/p>\n

Competing interests<\/i><\/b>: Martin McKee is a member of Independent SAGE, which was created in response to the secrecy of SAGE described in this article.<\/span><\/i><\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Cummings\u2019 evidence portrays a system that is not fit for purpose and goes some way to explaining why the UK\u2019s performance on covid-19 was so poor […]<\/p>\n

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