Sixth Report - Coronavirus: lessons learned to date
- HC No.
- HC 92
- Published
- 12 Oct 2021
- Items
- 200
- Response
- Response document linked (legacy; source unverified): Government’s Response to the Health and Soci… Read government response ↗
Select Committee · Science and Technology Committee (Commons)
Coronavirus: lessons learnt
Status: Closed
Opened: 6 Oct 2020
Closed: 28 May 2024
95 recommendations
305 conclusions
2 reports
Inquiry scope
The Health and Social Care Committee and Science and Technology Committee are holding a joint inquiry into lessons to be learned from the response to the coronavirus pandemic so far. The two Select Committees will jointly conduct evidence sessions examining the impact and effectiveness of action taken by government and the advice it has received. Each Committee will draw on specialist expertise and call witnesses to consider a range of issues including: • the deployment of non-pharmaceutical interventions like lockdown and social distancing rules to manage the pandemic; • the impact on the social care sector; • the impact on BAME communities and other at-risk groups; • testing and contact tracing; • modelling and the use of statistics; • Government communications and public health messaging; • the UK’s prior preparedness for a pandemic; and • the development of treatments and vaccines.Reports
Third Report - Coronavirus: lessons learned to date
- HC No.
- HC 92
- Published
- 12 Oct 2021
- Items
- 200
- Response
- Response document linked: Government Response to the Health and Social… Read government response ↗
Recommendations & Conclusions
The UK has established procedures and structures to prepare for the nation’s major future risks,...
Conclusion · source text
The UK has established procedures and structures to prepare for the nation’s major future risks, including a National Risk Register, the Civil Contingencies Secretariat and the Scientific Advisory Group for Emergencies (SAGE). However, the anticipated future risk of pandemic disease focused too closely on influenza rather than diseases like SARS and MERS that had in recent years appeared in Asian countries.
Department for Science, Innovation and Technology
Department of Health and Social Care
Previous exercises to test the national response capability, namely Exercises Cygnus and Winter Willow, did...
Conclusion · source text
Previous exercises to test the national response capability, namely Exercises Cygnus and Winter Willow, did not squarely address a disease with the characteristics of covid-19. Nevertheless, some useful lessons were learned and applied, such as the drafting of legislative measures that might be needed. 93 Healthcare Infection Society (CLL0071) 94 Q872; Paragraphs 318–19 95 Healthcare Infection Society (CLL0071) 96 Q941 30 Coronavirus: lessons learned to date
Department for Science, Innovation and Technology
Department of Health and Social Care
The operation of COBR was not well-suited to the modern demands of a pandemic response.
Conclusion · source text
The operation of COBR was not well-suited to the modern demands of a pandemic response. It is especially concerning that its culture of confidentiality was considered by some to be so unreliable that alternative meetings were arranged that could command greater confidentiality among participants.
Department for Science, Innovation and Technology
Department of Health and Social Care
The Civil Contingencies Secretariat did not have adequate resources to maintain a substantial standing capability...
Conclusion · source text
The Civil Contingencies Secretariat did not have adequate resources to maintain a substantial standing capability to survey the development of potential threats, and it had a limited reach into the range of Government departments required to respond to a pandemic. The experience has been that this investment in resilience is at risk of being trumped by the day-to-day pressures of Government.
Department for Science, Innovation and Technology
Department of Health and Social Care
Protocols to share data between public bodies involved in the response were too slow to...
Conclusion · source text
Protocols to share data between public bodies involved in the response were too slow to establish and to become functional. This was especially true in the data flows from national to local government.
Department for Science, Innovation and Technology
Department of Health and Social Care
The NHS responded quickly and strongly to the demands of the pandemic, but compared to...
Conclusion · source text
The NHS responded quickly and strongly to the demands of the pandemic, but compared to other health systems it “runs hot”—with little spare capacity built in to cope with sudden and unexpected surges of demand such as in a pandemic. Recommendations and lessons learned
Department for Science, Innovation and Technology
Department of Health and Social Care
A greater diversity of expertise and challenge—including from practitioners from other countries and a wider...
Recommendation · source text
A greater diversity of expertise and challenge—including from practitioners from other countries and a wider range of disciplines—should be included in the framing of the National Risk Register and the plans that emanate from it. Plans for the future should include a substantial and systematic method of learning from international practice during the course of an emergency.
Department for Science, Innovation and Technology
Department of Health and Social Care
A standing capability should be established in Government, or reporting to it, to scan the...
Recommendation · source text
A standing capability should be established in Government, or reporting to it, to scan the horizon for future threats, with adequate resource and counting on specialists with an independence from short-term political and administrative pressures.
Department for Science, Innovation and Technology
Department of Health and Social Care
The Government should ensure comprehensive plans are made for future risks and emergencies.
Recommendation · source text
The Government should ensure comprehensive plans are made for future risks and emergencies. The UK should aim to be a world leader in co-ordinating international resilience planning, including reform of the World Health Organisation to ensure that it is able to play a more effective role in future pandemics.
Department for Science, Innovation and Technology
Department of Health and Social Care
The resourcing and capabilities of the Civil Contingencies Secretariat should be improved.
Recommendation · source text
The resourcing and capabilities of the Civil Contingencies Secretariat should be improved. The Civil Contingencies Secretariat should be empowered to ‘stress test’ plans and to ensure that Departments are able to carry out a contingency plan if required. The details and results of these stress tests should be included in the Cabinet Office’s annual report.
Department for Science, Innovation and Technology
Department of Health and Social Care
Arrangements should be established and tested to allow immediate flows of data between bodies relevant...
Recommendation · source text
Arrangements should be established and tested to allow immediate flows of data between bodies relevant to an emergency response with a mechanism to resolve immediately and decisively any disputes.
Department for Science, Innovation and Technology
Department of Health and Social Care
The Armed Forces should have a more central and standing role in preparing for and...
Recommendation · source text
The Armed Forces should have a more central and standing role in preparing for and responding to emergencies like pandemics, given the depth of capability and experience they have in planning, logistics and rapid mobilisation. The Civil Contingencies Secretariat should work with the Armed Forces to improve operational expertise in emergencies in public bodies. Coronavirus: lessons learned to date 31
Department for Science, Innovation and Technology
Department of Health and Social Care
The Government and the NHS should consider establishing a volunteer reserve database so that volunteers...
Recommendation · source text
The Government and the NHS should consider establishing a volunteer reserve database so that volunteers who have had appropriate checks can be rapidly called up and deployed in an emergency rather than needing to begin from scratch.
Department for Science, Innovation and Technology
Department of Health and Social Care
The experience of the demands placed on the NHS during the covid-19 pandemic should lead...
Recommendation · source text
The experience of the demands placed on the NHS during the covid-19 pandemic should lead to a more explicit, and monitored, surge capacity being part of the long term organisation and funding of the NHS.
Department for Science, Innovation and Technology
Department of Health and Social Care
The NHS should develop and publish new protocols for infection prevention and control in pandemics...
Recommendation · source text
The NHS should develop and publish new protocols for infection prevention and control in pandemics covering staffing, bed capacity and physical infrastructure. In developing these protocols the NHS should consider the importance of maintaining access for people accompanying some patients such as advocates for people with learning disabilities and birthing partners.
Department for Science, Innovation and Technology
Department of Health and Social Care
Comprehensive analysis should be carried out to assess the safety of running the NHS with...
Recommendation · source text
Comprehensive analysis should be carried out to assess the safety of running the NHS with the limited latent capacity that it currently has, particularly in Intensive Care Units, critical care units and high dependency units.
Department for Science, Innovation and Technology
Department of Health and Social Care
Building on the experience of staff working more flexibly during the pandemic and to enable...
Recommendation · source text
Building on the experience of staff working more flexibly during the pandemic and to enable more flexible staffing in the NHS, NHS England and Health Education England should develop proposals to better enable NHS staff to change clinical specialty mid-career and train in sub-specialties. 32 Coronavirus: lessons learned to date 3 Lockdowns and social distancing
Department for Science, Innovation and Technology
Department of Health and Social Care
Much of the impact of covid-19 during the first wave was determined by decisions made...
Conclusion · source text
Much of the impact of covid-19 during the first wave was determined by decisions made during the early weeks of the pandemic, between January and late March 2020. The seriousness of the threat to the UK was recognised in January when the Government’s Scientific Advisory Group for Emergencies—SAGE—was convened and met on 22 January 2020.97 It is important to record that all decisions taken during those initial weeks were taken in a fog of uncertainty. The UK did not know to what extent covid-19 had entered the country, how many people it was affecting, how quickly it would spread, and what would be the consequences in terms of illness and death. What the UK did know was bleak: from the experience of China and Italy, it was clear that covid-19 was a highly infectious virus, with profound consequences for health, and for which there was no cure nor effective treatments. This meant that the only tools available to affect the spread of the pandemic were isolating people who had contracted the virus and their contacts, and, more generally restricting contacts between people, collectively known as non-pharmaceutical interventions, or NPIs.
Department for Science, Innovation and Technology
Department of Health and Social Care
The veil of ignorance through which the UK viewed the initial weeks of the pandemic...
Conclusion · source text
The veil of ignorance through which the UK viewed the initial weeks of the pandemic was partly self-inflicted. As we examine in depth in Chapter 4, the UK failed to turn an early lead in developing a test for covid in January 2020 into a testing operation that was adequate for the needs of the country—depriving scientists and policymakers of crucial granular data. Our Committees heard that the UK did not take enough advantage of the learning and experience being generated in other countries, notably in East Asia.98 The approach the UK took was particular, and in some respects exceptional.
Department for Science, Innovation and Technology
Department of Health and Social Care
The initial UK policy was to take a gradual and incremental approach to introducing non-pharmaceutical...
Conclusion · source text
The initial UK policy was to take a gradual and incremental approach to introducing non-pharmaceutical interventions. A comprehensive lockdown was not ordered until 23 March 2020—two months after SAGE first met to consider the national response to covid- 19.99 This slow and gradualist approach was not inadvertent, nor did it reflect bureaucratic delay or disagreement between Ministers and their advisers. It was a deliberate policy— proposed by official scientific advisers and adopted by the Governments of all of the nations of the United Kingdom.100 It is now clear that this was the wrong policy, and that it led to a higher initial death toll than would have resulted from a more emphatic early policy. In a pandemic spreading rapidly and exponentially every week counted. The former SAGE participant Professor Neil Ferguson told the Science and Technology Committee that if the national lockdown had been instituted even a week earlier “we would have reduced the final death toll by at least a half”.101
Department for Science, Innovation and Technology
Department of Health and Social Care
As a result, decisions on lockdowns and social distancing during the early weeks of the...
Conclusion · source text
As a result, decisions on lockdowns and social distancing during the early weeks of the pandemic—and the advice that led to them—rank as one of the most important public health failures the United Kingdom has ever experienced. This happened despite the UK 97 GOV.UK, ‘Precautionary SAGE 1 minutes: Coronavirus (COVID-19) response, 22 January 2020’, accessed 17 August 2021 98 See, for example: Q114, Q473, Q716, Q746 and Q1227 99 GOV.UK, ‘Prime Minister’s statement on coronavirus (COVID-19): 23 March 2020’, accessed 17 August 2021 100 See, for example: On 16 March SAGE advised “that there is clear evidence to support additional social distancing measures be introduced as soon as possible”—GOV.UK, ‘SAGE 16 minutes: Coronavirus (COVID-19) response, 16 March 2020’, accessed 17 August 2021 101 Oral evidence taken before the Science and Technology Committee on 10 June 2020, HC (2019–21) 136, Q883 Coronavirus: lessons learned to date 33 counting on some of the best expertise available anywhere in the world, and despite having an open, democratic system that allowed plentiful challenge. Painful though it is, the UK must learn what lessons it can of why this happened if we are to ensure it is not repeated. The initial policy: flattening the peak
Department for Science, Innovation and Technology
Department of Health and Social Care
There has been considerable debate as to whether the early policy of the Government was...
Conclusion · source text
There has been considerable debate as to whether the early policy of the Government was one of seeking to achieve so-called “herd-immunity”. The US Centres for Disease Control and Prevention defines community immunity/herd immunity as: A situation in which a sufficient proportion of a population is immune to an infectious disease (through vaccination and/or prior illness) to make its spread from person to person unlikely. Even individuals not vaccinated (such as newborns and those with chronic illnesses) are offered some protection because the disease has little opportunity to spread within the community. Also known as herd immunity.102
Department for Science, Innovation and Technology
Department of Health and Social Care
Non-pharmaceutical interventions such as lockdowns, and the testing and isolation of covid cases and their...
Conclusion · source text
Non-pharmaceutical interventions such as lockdowns, and the testing and isolation of covid cases and their contacts, are tools of temporary application. Once they are lifted, there is nothing to stop transmission resuming. When Sir Patrick Vallance said at a Government press conference on 12 March 2020 “it’s not possible to stop everybody getting it and it’s also actually not desirable because you want some immunity in the population. We need to have immunity to protect ourselves from this in the future”103 he was, in a sense, merely stating what were thought to be the facts of the time. Sir Patrick, and Ministers, have insisted that this statement was not a policy to seek herd immunity but a description of the situation. Matt Hancock wrote, as Secretary of State, on 14 March 2020: We have a plan, based on the expertise of world-leading scientists. Herd immunity is not a part of it. That is a scientific concept, not a goal or a strategy. Our goal is to protect life from this virus, our strategy is to protect the most vulnerable and protect the NHS through contain, delay, research and mitigate.104
Department for Science, Innovation and Technology
Department of Health and Social Care
From our evidence this appears to have led to a policy approach of fatalism about...
Conclusion · source text
From our evidence this appears to have led to a policy approach of fatalism about the prospects for covid in the community: seeking to manage, but not suppress, infection. This amounted in practice to accepting that herd immunity by infection was the inevitable outcome, given that the United Kingdom had no firm prospect of a vaccine, limited testing capacity and there was a widespread view that the public would not accept a lockdown for a significant period.105 That said, an initial unwillingness to consider seriously and act on the approach being taken in Taiwan, Singapore or Korea was a serious error. But even without an effective test and trace system earlier, social distancing and locking down would have bought much-needed time: time for vaccine research to bear fruit; time for treatments to be developed that could mean that experiencing covid-19 was less serious; time for test and trace systems to be developed and made effective so that the prevalence of the disease could be lowered without the entire population being restricted. The loss of 102 US Centres for Disease Control and Prevention, ‘glossary’, accessed 17 September 2021 103 10 Downing Street YouTube Channel, ‘UK Prime Minister Boris Johnson holds a press conference on coronavirus: 12 March 2020’, timestamp 10:43, accessed 17 August 2021 104 The Telegraph, We must do everything in our power to protect lives, Matt Hancock, 14 March 2020 105 See paragraphs 108–111 34 Coronavirus: lessons learned to date that time was to prove fatal to many. It would, however, be an overstatement to say that the Government and its advisers were promoting the acquisition of covid-19 to accelerate herd immunity in the population. But, in early Spring 2020, given that no alternative strategy was being implemented, that was the effective consequence. It was principally the threat of the NHS being overwhelmed that forced—belatedly—a change in direction.
Department for Science, Innovation and Technology
Department of Health and Social Care
So in the absence of a vaccine or an effective treatment being available at first,...
Conclusion · source text
So in the absence of a vaccine or an effective treatment being available at first, the UK faced a choice of doing everything possible to halt the virus, or seeking instead to moderate the pace of its spread. The UK chose the latter.106
Department for Science, Innovation and Technology
Department of Health and Social Care
Even as late as 12 March 2020, as noted in paragraph 80, Sir Patrick Vallance,...
Conclusion · source text
Even as late as 12 March 2020, as noted in paragraph 80, Sir Patrick Vallance, Government Chief Scientific Adviser, told a Government press conference that it was not possible to stop everyone being infected, and nor was that a desirable objective. The following day in a media interview Sir Patrick said that the aim of policy was: To try and reduce the peak, broaden the peak, not to suppress it completely. Also, because most people, the vast majority of people, get a mild illness, to build up some degree of herd immunity as well so that more people are immune to this disease and we reduce the transmission at the same time we protect those who are most vulnerable from it. Those are the key things we need to do.107 This reflected the views of the 23 people who participated in the SAGE meeting on 13 March, where the Group “was unanimous that measures seeking to completely suppress spread of Covid-19 will cause a second peak.”108 In practice this meant that social distancing policies were introduced gradually over a period of weeks.
Department for Science, Innovation and Technology
Department of Health and Social Care
The Government’s action plan of 3 March indicated that there was no intention to bring...
Conclusion · source text
The Government’s action plan of 3 March indicated that there was no intention to bring in a lockdown as strict as had been implemented in some other parts of the world. The action plan, under the heading ‘the Delay phase - next steps’ said: Action that would be considered could include population distancing strategies (such as school closures, encouraging greater home working, reducing the number of large-scale gatherings) to slow the spread of the disease throughout the population, while ensuring the country’s ability to continue to run as normally as possible.109 That approach meant that events that may have spread the virus proceeded—such as the football match between Liverpool FC and Atletico Madrid on 11 March—the day the coronavirus was categorised as a pandemic by the WHO—with a reported crowd of over 50,000110 and the Cheltenham Festival of Racing between 10 and 13 March, attracting more than 250,000 people.111 Subsequent analysis suggested that there were an additional 106 Evidence to the Science and Technology Committee in June 2020 from Professor Johan Giesecke, Former State Epidemiologist for Sweden and Professor Emeritus, Karolinska Institute, explained Sweden’s approach of a country asking individuals to change their behaviours without legislating for restrictions to be imposed. Q850 107 BBC Radio 4 Today, 13 March 2020—see Tweet by BBC Radio 4 Today (@BBCr4Today), 13/03/2020, 9.04am 108 GOV.UK, SAGE 15, 13 March 2020 109 GOV.UK, ‘Coronavirus: action plan’, accessed 17 September 2021 110 See, for example: ‘Liverpool vs Atletico Madrid: The Champions League match that should never have happened’, inews, 21 April 2020 111 ITV, ‘Coronavirus: Cheltenham festival and Liverpool Champions League game ‘likely increased suffering and death’’, 26 May 2020, accessed 2 September 2021 Coronavirus: lessons learned to date 35 37 and 41 deaths respectively at local hospitals after these events.112 However, it is not clear whether those deaths were as a result of atten
Department for Science, Innovation and Technology
Department of Health and Social Care
At its meeting of 5 March 2020, SAGE reconfirmed an explicitly gradual approach: There is...
Conclusion · source text
At its meeting of 5 March 2020, SAGE reconfirmed an explicitly gradual approach: There is epidemiological and modelling data to support implementation– within 1 to 2 weeks–of individual home isolation (symptomatic individuals to stay at home for 14 days) and whole family isolation (fellow household members of symptomatic individuals to stay at home for 14 days after last family member becomes unwell) to delay COVID-19 spread, modify the epidemic peak and reduce mortality rates. In addition, there is scientific data to support implementation–roughly 2 weeks later–of social isolation (cocooning) for those over 65 or with underlying medical conditions to delay spread, modify the epidemic peak and reduce mortality rates.113 SAGE had, however, considered advice to take a more robust precautionary approach. It received a paper, one of three, from the London School of Hygiene and Tropical Medicine on the considerations for non-pharmaceutical interventions. The paper said, with moderate confidence, that “NPIs that reduce transmission substantially should be introduced later but before the peak.”114 The same paper stated that: • Taking all into consideration, building up of NPIs in terms of intensity during the epidemic has many advantages: • It provides the opportunity for modification / improvement as we see the epidemic progress, i.e. it is robust to possible futures • It leaves room for policy modification during the epidemic, and avoids the situation in late summer if an epidemic has been curbed or greatly reduced that a larger epidemic is still expected.115
Department for Science, Innovation and Technology
Department of Health and Social Care
On 9 March 2020, SAGE set out a number of non-pharmaceutical interventions that could in...
Conclusion · source text
On 9 March 2020, SAGE set out a number of non-pharmaceutical interventions that could in due course be introduced by the Government. SAGE advised that “measures relating to individual and household isolation will likely need to be enacted within the next two weeks to be fully effective, and those concerning social distancing of the elderly and vulnerable 2–3 weeks after this”.116 On 12 March 2020, the Prime Minister said that anyone with a new continuous cough or a fever should self-isolate for seven days.117 Household isolation was announced on 16 March 2020.118 112 Edge Health, Understanding the role of large gatherings on the NHS, 28 May 2020. The analysis states that their findings cannot be used to establish causality 113 GOV.UK, SAGE 13, 5 March 2020 114 London School of Hygiene & Tropical Medicine, Considerations for NPI Policy – timing and sub-national targeting, 5 March 2020 115 London School of Hygiene & Tropical Medicine, Considerations for NPI Policy – timing and sub-national targeting, 5 March 2020 116 GOV.UK, Potential impact of behavioural and social interventions on an epidemic of Covid-19 in the UK, 9 March 2020 117 GOV.UK, ‘Prime Minister’s statement on COVID-19: 12 March 2020’, accessed 17 September 2021 118 GOV.UK, ‘Prime Minister’s statement on coronavirus (COVID-19): 16 March 2020’, accessed 17 September 2021 36 Coronavirus: lessons learned to date
Department for Science, Innovation and Technology
Department of Health and Social Care
It is striking, looking back, that it was accepted that the level of covid-19 infection...
Conclusion · source text
It is striking, looking back, that it was accepted that the level of covid-19 infection in the UK could be controlled by turning on particular non-pharmaceutical interventions at particular times. Indeed such was the belief in this ability to calibrate closely the response that a forward programme of interventions was published with the suggestion that they would be deployed only at the appropriate moment.119 In hindsight it seems a dubious and risky assumption to think that a new, unknown and rampant virus could be regulated in such a precise way. Even more so when—due to the early failure to establish a meaningful testing programme—the UK had very little data on the prevalence and spread of the virus across different settings and different groups of people.
Department for Science, Innovation and Technology
Department of Health and Social Care
This was not the only way to proceed, and indeed the UK was an outlier...
Conclusion · source text
This was not the only way to proceed, and indeed the UK was an outlier internationally in the gradualist approach that was being taken before late March.120 Countries in East Asia were the first to experience covid-19. Their response was a much more rapid and muscular imposition of social distancing and requirements to isolate.121
Department for Science, Innovation and Technology
Department of Health and Social Care
On 24 February the World Health Organisation published the report of its international mission to...
Conclusion · source text
On 24 February the World Health Organisation published the report of its international mission to Wuhan, and advised that countries should: (1) Immediately activate the highest level of national Response Management protocols to ensure the all-of-government and all-of-society approach needed to contain COVID-19 with non-pharmaceutical public health measures; (2) Prioritize active, exhaustive case finding and immediate testing and isolation, painstaking contact tracing and rigorous quarantine of close contacts122 The same report identified the virus as highly contagious, and with a prima facie case fatality rate of 3.8%, rising to over 20% among over 80s.123
Department for Science, Innovation and Technology
Department of Health and Social Care
In evidence to the Science and Technology Committee on 25 March 2020, the Editor of...
Conclusion · source text
In evidence to the Science and Technology Committee on 25 March 2020, the Editor of The Lancet, Dr Richard Horton, said that his journal had published articles on 24, 29 and 31 January with an analysis of the situation in China.124 He told the Committee: Those papers were truly alarming and showed that the disease caused a serious fatal pneumonia. A third of patients who had been reported in those papers required admission to the intensive care unit. The number of deaths that were being described was rising quickly. The authors of the papers were advocating the immediate provision of personal protective equipment and were urging the importance of testing and isolation. They were describing the fact that there was no effective treatment and also emphasising the pandemic potential. 119 GOV.UK, SAGE 12, Potential impact of behavioural and social interventions on an epidemic of Covid-19 in the UK, 9 March 2020 120 See footnote 108 121 See, for example: Q113, Q119 and Q474. 122 World Health Organisation, Report of the WHO-China Joint mission on Coronavirus Disease 2019 (COVID-19): 16–24 February 2020, p21 123 These were estimates of the fatality rate of covid-19 in February 2020 124 Oral evidence taken before the Science and Technology Committee on 25 March 2020, HC (2019–21) 136, Q39 Coronavirus: lessons learned to date 37 Those were the people from the frontlines of the epidemic at the end of January. Many of us at The Lancet felt that that was a red flag. We have had seven to eight weeks since that time, and February was the opportunity for the UK to really prepare, based on testing, isolation, quarantine, physical distancing, ICU capacity and so on. I think you described it as being critical and, yes, it was, in the sense that we missed that opportunity. We could have used the month of February, based on what we knew in January. When I look at the evidence that SAGE posted on the website—there is a lot of evidence and it is great that they have been so transparent—wh
Department for Science, Innovation and Technology
Department of Health and Social Care
The UK policy was to change abruptly.
Conclusion · source text
The UK policy was to change abruptly. During the days before 23 March, multiple people within the Government and its advisers experienced simultaneous epiphanies that the course the UK was following was wrong, possibly catastrophically so. In his evidence to our inquiry Dominic Cummings told us: On Friday the 13th [of March 2020], we then started to look through all the information and we started to pick apart all the different graphs. Ben [a No. 10 Specialist Adviser] spoke to Patrick; Patrick said, “I am also extremely concerned. It seems that something has gone fundamentally wrong in the wiring of the system. We have these graphs showing that even on the best- case scenario with the official plan, you are going to completely smash through the capacity of the NHS—not by a little bit but multiple times.” The evening of Friday the 13th, I am sitting with Ben Warner and the Prime Minister’s Private Secretary in the Prime Minister’s study. We were basically saying that we are going to have to sit down with the Prime Minister tomorrow and explain to him that we think that we are going to have to ditch the whole official plan, and we are heading for the biggest disaster this country has seen since 1940.127 125 Oral evidence taken before the Science and Technology Committee on 25 March 2020, HC (2019–21) 136, Q39 126 BBC, “Coronavirus: Italy extends emergency measures nationwide”, 10 March 2020; BBC, “Coronavirus: Spain set to declare national lockdown”, 14 March 2020; Metro, “ Netherlands becomes latest country to go into lockdown in battle against coronavirus”, 15 March 2020; France24, “Macron announces 15-day lockdown in French ‘war’ on coronavirus”, 16 March 2020 127 Q1003 38 Coronavirus: lessons learned to date Mr Cummings went on to tell us that other senior officials were recognising that the UK’s approach and epidemiological trajectory was on course for a “disaster”: At this point, the second most powerful official in the country, Helen MacNamara—the Deputy Cabin
Department for Science, Innovation and Technology
Department of Health and Social Care
In evidence to the Science and Technology Committee in July 2020, Sir Patrick Vallance, said...
Conclusion · source text
In evidence to the Science and Technology Committee in July 2020, Sir Patrick Vallance, said that SAGE advised the Government to implement the remainder of the menu of options for social distancing measures—in essence a full lockdown—on 16 or 18 March 2020: When the SAGE sub-group on modelling, SPI-M, saw that the doubling time had gone down to three days, which was in the middle of March, that was when the advice SAGE issued was that the remainder of the measures should be introduced as soon as possible. I think that advice was given on 16 or 18 March, and that was when those data became available. Looking 128 Q1003 129 Q1006 130 Q1293 Coronavirus: lessons learned to date 39 back, you can see that the data may have preceded that, but the data were not available before that. Knowledge of the three-day doubling rate became evident during the week before.131 On 16 March 2020, SAGE minutes show that the group concluded that additional measures, beyond those already in place, were required: “SAGE advises that there is clear evidence to support additional social distancing measures be introduced as soon as possible”.132 Sir Patrick explained that SAGE changed its advice on the basis that case numbers were doubling every three days, which was quicker than initially thought.133 Moreover, at the same meeting, SAGE considered a paper from Imperial College London academics, Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand.134 The paper concluded that “in an unmitigated epidemic, we would predict approximately 510,000 deaths in GB and 2.2 million in the US, not accounting for the potential negative effects of health systems being overwhelmed on mortality.”135 It was widely reported that this paper was a key factor in the Government’s decision to impose a full lockdown.136 SPI-M-O had also produced a consensus view that “general social distancing and school closures to case isolation, household isolation and social distancing o
Department for Science, Innovation and Technology
Department of Health and Social Care
It seems astonishing looking back that—despite the documented experiences of other countries; despite the then...
Conclusion · source text
It seems astonishing looking back that—despite the documented experiences of other countries; despite the then Secretary of State referring to data with a Reasonable Worst Case Scenario of 820,000 deaths;138 despite the raw mathematics of a virus which, if it affected two-thirds of the adult population and if one percent of people contracting it died would lead to 400,000 deaths—it was not until 16 March that SAGE advised the Government to embark on a full lockdown (having said on 13 March that “it was unanimous that measures seeking to completely suppress the spread of covid-19 will cause a second peak”)139 and not until 23 March that the Government announced it. Border controls
Department for Science, Innovation and Technology
Department of Health and Social Care
The UK did not impose blanket or rigorous border controls at the onset of the...
Conclusion · source text
The UK did not impose blanket or rigorous border controls at the onset of the covid-19 pandemic as compared to other countries, particularly in East and South East Asia.140 Instead, the UK implemented light-touch border controls only on countries and regions where there was a recorded high incidence rate. While the UK initially focused on China, Iran, South Korea and Italy, a significant number of cases came from elsewhere. A 131 Oral evidence taken before the Science and Technology Committee on 16 July 2020, HC (2019–21) 136, Q1079 132 GOV.UK, SAGE 16, 16 March 2020 133 Oral evidence taken before the Science and Technology Committee on 16 July 2020, HC (2019–21) 136, Q1079 134 Imperial College COVID-19 Response Team, Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand, 16 March 2020 135 Imperial College COVID-19 Response Team, Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand, 16 March 2020 136 For example, see: Financial Times, ‘The shocking coronavirus study that rocked the UK and US’ 137 GOV.UK, SPI-M-O: consensus view on behavioural and social interventions, 16 March 2020 138 See paragraph 91. 139 GOV.UK, SAGE 15, 13 March 2020 140 For example, on 28 January 2020, all inbound travellers from Wuhan were subject to isolation; from 26 February 2020, Singapore banned all arrivals from Cheongdo and Daegu in South Korea; from 3 February 2020, Hong Kong began to close border crossing posts. 40 Coronavirus: lessons learned to date study found that 33% of cases during the first wave were introduced from Spain and 29% were introduced from France.141 The number of seeding events that occurred early in the pandemic, coupled with the lack of data, made the lockdown almost inevitable.
Department for Science, Innovation and Technology
Department of Health and Social Care
By contrast, other countries implemented more rigorous border controls which were more effective at suppressing...
Conclusion · source text
By contrast, other countries implemented more rigorous border controls which were more effective at suppressing the virus and preventing the need for long and repeated lockdowns. However, even though it is not straightforward to make direct comparisons between countries, and it is yet to be seen how countries like New Zealand will fare when their borders are opened, it is reasonable to say that a more precautionary approach would have been beneficial at the start of the pandemic. Reasons for the delay in full lockdown
Department for Science, Innovation and Technology
Department of Health and Social Care
In the paragraphs that follow we consider some of the potential explanations of why the...
Recommendation · source text
In the paragraphs that follow we consider some of the potential explanations of why the initial decision-making on lockdowns was wrong, and what lessons can be drawn for the future from this. Should the Government have unilaterally taken a precautionary view in the first weeks, despite the SAGE advice?
Department for Science, Innovation and Technology
Department of Health and Social Care
The UK’s structure of scientific advice in emergencies, in which a group is formed of...
Conclusion · source text
The UK’s structure of scientific advice in emergencies, in which a group is formed of relevant experts (SAGE) to advise the Government is a prominent feature of our arrangements—much more so than in many other countries. Initially, participation in SAGE was not disclosed, nor the papers on which its advice drew, nor the minutes of its meetings. Following pressure, including from the House of Commons Science and Technology Committee, and supported by the Government Chief Scientific Adviser Sir Patrick Vallance,142 details of papers considered by SAGE were published from 20 March 2020; the individuals participating in SAGE were published from 4 May 2020; and minutes from 29 May 2020.143 Publication revealed that SAGE comprised a large number of scientific experts of high standing—over 85 individuals are listed as having participated in SAGE since its first meeting during the pandemic.144
Department for Science, Innovation and Technology
Department of Health and Social Care
SAGE provides advice to Ministers, whose responsibility it is to make policy decisions.
Conclusion · source text
SAGE provides advice to Ministers, whose responsibility it is to make policy decisions. However, witnesses to our Committees confirmed that during the early months of the pandemic the Government acted on the scientific advice it was given. Sir Patrick Vallance, for example, told the Science and Technology Committee on 25 March 2020 that there had been no significant disagreement between the Government and its scientific advisers on anything material.145
Department for Science, Innovation and Technology
Department of Health and Social Care
We accept that it is difficult for Ministers to go against a scientific consensus among...
Conclusion · source text
We accept that it is difficult for Ministers to go against a scientific consensus among the body set up to provide scientific advice during a national emergency. We also understand the reluctance to introduce measures with significant negative economic impact. But the 141 Imperial College London, ‘COVID-19 transmission chains in the UK traced back to Spain, France and Italy’, accessed 17 September 2021 142 Rt Hon Greg Clark MP, Chair, Science and Technology Committee (Qq75–76); Correspondence from the Chair to Sir Patrick Vallance, Chief Scientific Adviser, relating to SAGE Membership, 30 March 2020; and correspondence from Sir Patrick Vallance, Chief Scientific Adviser, relating to transparency of scientific evidence: social distancing, 28 May 2020 143 Science and Technology Committee, First Report of Session 2019–21, The UK response to covid-19: use of scientific advice, HC 136, paragraphs 55 and 71–72 144 GOV.UK, ‘List of participants of SAGE and related sub-groups’, accessed 17 August 2021 145 Oral evidence taken before the Science and Technology Committee on 25 March 2020, HC (2019–21) 136, Q81 Coronavirus: lessons learned to date 41 early weeks of the pandemic expose deficiencies in both scientific advice and Government action. In the early days of an emergency, formulating the best scientific advice is challenging: there are, for example, inevitable lags in acquiring and analysing data. Other countries took early decisions that were more seen as those of Government leaders rather than from established scientific evidence146 and it is possible that this provided a greater licence to take decisions more quickly, and on a more precautionary basis than happened in the UK—contributing to better overall outcomes. Was there sufficient challenge to scientific advice during the first weeks?
Department for Science, Innovation and Technology
Department of Health and Social Care
Several witnesses to our inquiry, reflecting on the early weeks of the pandemic, were rueful...
Conclusion · source text
Several witnesses to our inquiry, reflecting on the early weeks of the pandemic, were rueful that they did not sufficiently question and challenge the advice they were being given. We heard that challenging an established scientific consensus was difficult. Dominic Cummings told us: It was clear through all the meetings with PHE and everybody that everything was going wrong; everything we pushed, everything we probed—everything was wrong, bad, terrible. But I was incredibly frightened—I guess is the word—about the consequences of me kind of pulling a massive emergency string and saying, “The official plan is wrong, and it is going to kill everyone, and you’ve got to change path,” because what if I’m wrong? What if I persuade him [the Prime Minister] to change tack and that is a disaster? Everyone is telling me that if we go down this alternative path, it is going to be five times worse in the winter, and what if that is the consequence?147
Department for Science, Innovation and Technology
Department of Health and Social Care
The then Secretary of State, Matt Hancock MP, made the same point regarding the difficulty...
Conclusion · source text
The then Secretary of State, Matt Hancock MP, made the same point regarding the difficulty of challenging a scientific consensus.148 On 28 January 2020, SAGE said that testing asymptomatic individuals would “not be useful”.149 However, at the same meeting, SAGE went on to say that there was “limited evidence of asymptomatic transmission, but early indications imply some is occurring.”150 Matt Hancock told us that he thought asymptomatic transmission was occurring, but he found it difficult to challenge the scientific consensus: I was in a situation of not having hard evidence that a global scientific consensus of decades was wrong but having an instinct that it was. I bitterly regret that I did not overrule that scientific advice at the start and say that we should proceed on the basis that there is asymptomatic transmission until we know there is not, rather than the other way round. But when you are faced with a global consensus, and you do not have the evidence that you are right and the scientific consensus is wrong, it is hard to do that.151 146 For example, see “Coronavirus cases have dropped sharply in South Korea. What’s the secret to its success?”, 17 March 2020; and comments by Prof Balloux and Dr Groppelli, 10 March 2020 147 Q1008 148 Q1302 149 GOV.UK, SAGE 2, paragraph 16, 28 January 2020 150 GOV.UK, SAGE 2, paragraph 16, 28 January 2020 151 Q1302 42 Coronavirus: lessons learned to date We also note that Nobel Laureates Sir Paul Nurse and Sir Peter Ratcliffe wrote to the then Secretary of State to warn about asymptomatic transmission and the need for testing in April 2020. However, they did not receive a substantive response until July and only then from a correspondence clerk rather than the then Secretary of State.152 We continue to await a response from the Department on why action was not taken on asymptomatic transmission and testing earlier.153
Department for Science, Innovation and Technology
Department of Health and Social Care
We accept that it is difficult to challenge a widely held scientific consensus.
Conclusion · source text
We accept that it is difficult to challenge a widely held scientific consensus. But accountability in a democracy depends on elected decision-makers taking advice, but examining, questioning and challenging it before making their own decisions. We find it surprising that the fatalistic assumptions behind the initial scientific advice were not challenged until it became clear the NHS could be overwhelmed, particularly given alternative strategies were being pursued visibly and successfully in East Asian countries. We heard that ‘red teaming’ and structured challenge was used within the national security community, which may also be of benefit to the scientific community.154 Kate Bingham also pointed out that the Government may have benefited from more scientists within the Civil Service155 We acknowledge that the then Secretary of State told us that he had challenged scientific advice regarding asymptomatic transmission.156 However, this came after the key moments in mid-March when challenge was needed most, and after the WHO had warned of asymptomatic transmission. The influence of modelling during the pandemic
Department for Science, Innovation and Technology
Department of Health and Social Care
In his evidence to the Science and Technology Committee during the early weeks of the...
Conclusion · source text
In his evidence to the Science and Technology Committee during the early weeks of the pandemic, on 25 March, the Editor of the Lancet expressed concern that mathematical modelling was playing too influential a role in UK scientific advice.157 The prominence of modelling and projections was, and still remains, an important part of the UK’s response to covid-19. Models can be useful and informative to policymakers, but they come with limitations. As Professor Neil Ferguson told the Science and Technology Committee in June 2020, “Models can only be as reliable as the data that is feeding into them.”158 However, we know that—especially in the early stages of the pandemic—there was an acute shortage of good data.159 There was also a limited understanding of the virus early in the pandemic. Key questions, such as the length of immunity conferred by infection, were unknown and hampered accurate modelling.160
Department for Science, Innovation and Technology
Department of Health and Social Care
Evidence to the Science and Technology Committee from other academic disciplines included scepticism of the...
Conclusion · source text
Evidence to the Science and Technology Committee from other academic disciplines included scepticism of the weight being placed on mathematical models during the pandemic. For example Professor Sir John Kay, Economist and Fellow in Economics, St 152 Correspondence from Rt Hon Greg Clark and Rt Hon Jeremy Hunt to Matt Hancock, 22 June 2021 153 After the Report was agreed by the Committees a response from Rt Hon Sajid Javid MP, Secretary of State for Health and Social Care, was received. 154 Q743 155 Oral evidence taken before the Science and Technology Committee on 4 November 2020, HC (2019–21) 136, Q282 156 Q1300 157 See, for example: oral evidence taken before the Science and Technology Committee on 25 March 2020, HC (2019–21) 136, Q40 and Q42. 158 Oral evidence taken before the Science and Technology Committee on 10 June 2020, HC (2019–21) 136, Q889 159 For example, see: SAGE 14, 10 March 2020, paragraph 36 160 Oral evidence taken before the Science and Technology Committee on 10 June 2020, HC (2019–21) 136, Q841 Coronavirus: lessons learned to date 43 John’s College, University of Oxford, told the Science and Technology Committee in June 2020 that models did not necessarily respond well to change and should not be used to make predictions: economic models tend to work pretty well as long as nothing much changes, which does not help them to be a great deal of use. What really matters from this point of view is understanding the nature of the underlying change. […] In my view, the use of economic models and other models is not so much to make predictions as to give people better insights into what is going on, and that is the way in which models ought to be used.161 Professor Carol Propper, Professor of Economics, Imperial College London and President of the Royal Economic Society, illustrated that assumptions in models had not always borne out and there was a need for up-to-date data: To give one more example of the need for that data, when we shut down hospitals
Department for Science, Innovation and Technology
Department of Health and Social Care
Sir John also highlighted concerns about how different academic disciplines did not collaborate sufficiently on...
Conclusion · source text
Sir John also highlighted concerns about how different academic disciplines did not collaborate sufficiently on models.164 Professor James Poterba, Mitsui Professor of Economics, Massachusetts Institute of Technology, explained to the Science and Technology Committee that the consequence of this was that some costs were not factored into models earlier in the pandemic: Many in epidemiology and in the health services area have realised that the economic cost of some of the policies their models suggested were very important to understand, and consequently they have become very concerned about building some more economics into those models in various ways.165 161 Oral evidence taken before the Science and Technology Committee on 5 June 2020, HC (2019–21) 136, Qq764– 765 162 Oral evidence taken before the Science and Technology Committee on 5 June 2020, HC (2019–21) 136, Q774 163 Oral evidence taken before the Science and Technology Committee on 5 June 2020, HC (2019–21) 136, Q768 164 Oral evidence taken before the Science and Technology Committee on 5 June 2020, HC (2019–21) 136, Q767 165 Oral evidence taken before the Science and Technology Committee on 5 June 2020, HC (2019–21) 136, Q770 44 Coronavirus: lessons learned to date
Department for Science, Innovation and Technology
Department of Health and Social Care
Professor Chris Whitty noted that he preferred advice to be given on the basis of...
Conclusion · source text
Professor Chris Whitty noted that he preferred advice to be given on the basis of observed data, telling the Science and Technology Committee in November 2020: “It is important to say that a lot of the advice that I have given is not based on significant forward modelling. It is based on what is happening and what is observable.”166
Department for Science, Innovation and Technology
Department of Health and Social Care
Yet despite this, throughout the pandemic, detailed modelled projections have assumed a great prominence and...
Conclusion · source text
Yet despite this, throughout the pandemic, detailed modelled projections have assumed a great prominence and have evidently had great influence on Government decisions. Indeed, the publication of the Imperial study of 16 March, is often cited as one of the main triggers for the abandonment of the initial policy of flattening the peak of covid, and its replacement with the one of suppression, in line with many other countries.167 Assumptions about behavioural compliance
Department for Science, Innovation and Technology
Department of Health and Social Care
Another potential reason for the late lockdown was the behavioural advice that was being tendered...
Conclusion · source text
Another potential reason for the late lockdown was the behavioural advice that was being tendered to the Government. Behavioural advice is tendered to the Government through SAGE’s sub-group, the Scientific Pandemic Insights Group on Behaviours (SPI- B).168 SPI-B’s first publicly known input into SAGE was on 25 February 2020 on the risk of public disorder.169
Department for Science, Innovation and Technology
Department of Health and Social Care
The initial action plan did not consider the possibility of ceasing all non-essential contact.
Conclusion · source text
The initial action plan did not consider the possibility of ceasing all non-essential contact. Dominic Cummings told us that the idea of behavioural fatigue was a part of “false groupthink”: One of the critical things that was completely wrong in the whole official thinking in SAGE and in the Department of Health in February/March was, first of all, the British public would not accept a lockdown and, secondly, the British public would not accept what was thought of as an east Asian-style track and trace-type system and the infringements of liberty around that.170 The then Secretary of State for Health and Social Care also indicated to us in June 2021 that “the clear advice at the time was that there was only a limited period that people would put up with it—would put up with lockdown.”171 On 9 March 2020, Professor Chris Whitty told a Government press conference: It is not just a matter of what you do but when you do it. Anything we do, we have got to be able to sustain. Once we have started these things we have to continue them through the peak and that is for a period of time, and there is a risk that, if we go too early, people will understandably get fatigued and it will be difficult to sustain this over time.172 Further, on 10 March 2020, SAGE said that: 166 Oral evidence taken before the Science and Technology Committee on 3 November 2020, HC (2019–21) 136, Q1438 167 Imperial College London, Report 9—impact on non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand, 16 March 2020; and BBC News, ‘Coronavirus: UK changes course amid death toll fears’, accessed 17 September 2021 168 GOV.UK, ‘List of participants of SAGE and related sub-groups’, accessed 17 September 2021 169 SPI-B, Risk of public disorder, 25 February 2020 170 Q1002 171 Q1294 172 10 Downing Street YouTube channel, PM Boris Johnson holds a press conference on coronavirus: 9 March 2020, timestamp 8:04, accessed 17 September 2021 Coronavirus: lessons learned to dat
Department for Science, Innovation and Technology
Department of Health and Social Care
It transpired that the UK public were very compliant with the eventual lockdown measures.175 Professor...
Conclusion · source text
It transpired that the UK public were very compliant with the eventual lockdown measures.175 Professor Chris Whitty also said in November 2020: Across the board, my reflection is that the great majority of people—and this is reflected in all the polling and a variety of other things—both intend to stick to the rules and do stick to the rules to a remarkable degree. To go back to Patrick’s point, were that not the case, we would be in a massively worse place than we are at the moment. My expectation is that R would have shot right up if people had not massively reduced the number of people they have contact with, had not stuck to all the things we need to do in individual actions they can take—such as hands, face and space—and businesses had not done a huge amount to try to make them Covid secure. Without that, we would be in a very difficult place compared with where we are now.176
Department for Science, Innovation and Technology
Department of Health and Social Care
The restrictions eventually imposed on the UK public because of the pandemic were unprecedented.
Conclusion · source text
The restrictions eventually imposed on the UK public because of the pandemic were unprecedented. Even in wartime there had been no equivalent of the order to make it a criminal offence for people to meet each other and to remain in their homes other than for specified reasons. In advance, it may not have been unreasonable to assume that the public would have a limited tolerance of such draconian restrictions. But that assumption turned out to be wrong. In the event, compliance with social distancing measures was at a level and for a duration beyond what was anticipated. If a belief that people would not comply delayed a full lockdown, and caused an initially limited set of non-pharmaceutical interventions to be adopted, this was a poor guide to policy. Was scientific advice sufficiently internationally diverse?
Department for Science, Innovation and Technology
Department of Health and Social Care
We have referred to early evidence from Dr Richard Horton, the Editor of the Lancet,...
Conclusion · source text
We have referred to early evidence from Dr Richard Horton, the Editor of the Lancet, who was concerned that SAGE in its early months was taking insufficient account of international perspectives. At the time he gave his evidence, Dr Horton, like the rest of the public, was not aware of the membership of SAGE. Now we are, and it is notable that 173 GOV.UK, SAGE 14, 10 March 2020 174 GOV.UK, SAGE 16, 16 March 2020 175 Office for National Statistics, ‘Coronavirus and the social impacts on behaviours during different lockdown periods, Great Britain: up to February 2021’, accessed 17 September 2021 176 Oral evidence taken before the Science and Technology Committee on 3 November 2020, HC (2019–21) 136, Q1517 46 Coronavirus: lessons learned to date of the 87 people listed as having participated in at least one meeting of SAGE, all bar one person (Dr Pasi Penttinen, European Centre for Disease Prevention and Control) are from UK institutions.177
Department for Science, Innovation and Technology
Department of Health and Social Care
It is a characteristic of the best UK scientific institutions, and the people that work...
Conclusion · source text
It is a characteristic of the best UK scientific institutions, and the people that work in them, that much of their research involves extensive international collaboration. However, for a virus that has affected every country in the world and which was experienced first by other countries, it is also right to consider whether our scientific advisory bodies are sufficiently international. This question arises not only in the context of the early decisions on lockdown but, as we will see in Chapter 4, Public Health England’s failure to evidence any formal evaluation of the test and trace policies of countries which had experienced covid before the UK.
Department for Science, Innovation and Technology
Department of Health and Social Care
Dr Horton expressed concerns about the evidence base that SAGE in its early meetings drew...
Conclusion · source text
Dr Horton expressed concerns about the evidence base that SAGE in its early meetings drew upon. Referring to scientists in East Asia, Dr Horton told the Science and Technology Committee: If I had been Chair of SAGE, I would have wanted to go to those scientists on the frontline saying, “Please come and tell us your experience. What is coming for us in the UK? Why are you sending this warning signal?” because it is not there in the SAGE evidence.178 Local lockdowns: the tier system
Department for Science, Innovation and Technology
Department of Health and Social Care
Although introduced several weeks after it should have been, the national lockdown brought in on...
Conclusion · source text
Although introduced several weeks after it should have been, the national lockdown brought in on 23 March succeeded in reducing the incidence of covid across the country, so that from May 2020 national restrictions were eased. However, tougher restrictions were maintained in areas where infections were higher. For example, the City of Leicester remained in lockdown measures from July to September 2020.179 The North West of England had stubbornly high levels of covid throughout the summer, and restrictions were imposed on Liverpool, Greater Manchester, Blackburn, and eventually the whole of the region on 29 September 2020.180
Department for Science, Innovation and Technology
Department of Health and Social Care
The Government sought to agree with local leaders the package of restrictions that would apply...
Conclusion · source text
The Government sought to agree with local leaders the package of restrictions that would apply in particular areas. However, the consequence of this approach led to political differences between national government and some local leaders as to what measures were appropriate for their area—most prominently, the Greater Manchester Mayor, Andy Burnham, and the Government being in a state of disagreement for 10 days during October before restrictions were imposed unilaterally.181
Department for Science, Innovation and Technology
Department of Health and Social Care
By mid-September 2020, case rates were rising across the country, but there were significant local...
Conclusion · source text
By mid-September 2020, case rates were rising across the country, but there were significant local differences. For example, on 30 September, the incidence of covid ranged from 607 per 100,000 population per week in East Sussex, to 4,318 in Knowsley.182 To 177 GOV.UK, ‘List of participants of SAGE and related sub-groups’, accessed 17 August 2021. One participant, Dr Demis Hassabis, attended in a personal capacity, so we do not include them in our analysis. 178 Oral evidence taken before the Science and Technology Committee on 25 March 2020, HC (2019–21) 136, Q40 179 House of Lords Library, ‘Leicester lockdown: Changes since July 2020’, accessed 17 August 2021 180 House of Commons Library, Coronavirus: A history of English lockdown laws, 30 April 2021; Health Protection (coronavirus, Restrictions) (North of England, North East and North West of England and Obligations of Undertakings (England) etc.) (Amendment) Regulations 2020 (SI 2020/1057) 181 HC Deb, 20 October 2020, cols 1015–16 [Commons Chamber] 182 GOV.UK, Coronavirus (COVID-19) in the UK: 30 September 2020, web archive, accessed 17 August 2021 Coronavirus: lessons learned to date 47 rationalise the increasingly disparate sets of restrictions being imposed on different places, on 12 October 2020, the Prime Minister announced a three-tier system of local restrictions:183 • Tier 1 maintained the rule of six184 and a 10pm curfew for hospitality; • Tier 2 did not permit indoor gatherings (including hospitality) but allowed gatherings of up to six people in outdoor settings; and • Tier 3 a ban on household mixing and hospitality being closed. Retail, schools, and personal care remained open.
Department for Science, Innovation and Technology
Department of Health and Social Care
As we discuss in Chapter 4, there had been hopes that by Autumn 2020 an...
Conclusion · source text
As we discuss in Chapter 4, there had been hopes that by Autumn 2020 an effective test, trace and isolate system—promised to be “world-beating”—would allow covid levels to be contained without recourse to extensive lockdown restrictions. Indeed the business case that the Test and Trace organisation put forward for Treasury approval cited the enormous savings that would result from being able to avoid a second lockdown as justifying the expenditure of £12bn requested from the Exchequer in September 2020 (the budget and expenditure of Test and Trace subsequently increased).185 As with the early failure of the test and trace system in February and March 2020—then under PHE’s management—to be of material assistance in stopping the spread of the pandemic like in East Asian Countries, the national test and trace operation failed once again to deliver the contribution it promised to avoiding social distancing measures from being required to take up the strain.
Department for Science, Innovation and Technology
Department of Health and Social Care
The experience of the tiered system during the autumn was, however, unsatisfactory.
Conclusion · source text
The experience of the tiered system during the autumn was, however, unsatisfactory. In the absence of effective contact tracing, the regional restrictions proved not to be anywhere near watertight enough to prevent infections spreading, compounded by delays in getting test results. Professor John Edmunds, Professor of Infectious Disease Epidemiology and a participant of SAGE, told us that he had concerns about what the tiering system would result in and that he would not have followed such a strategy: What worries me a little bit is where the strategy leads at the moment. If you think it through, the targeted strategy—the tiered strategy—leads to a high level of incidence everywhere. Let’s say that tier 3 works and keeps the reproduction number at about 1. I do not think anybody really thinks it will reduce it to less than 1. Let’s assume that it manages to get the reproduction number to about 1. That means that in Liverpool, Manchester and the north-west, we will keep the incidence at that high level, which is putting hospitals under strain and causing significant numbers of deaths. We are going to keep it at that high level for the foreseeable future. 183 HC Deb, 12 October 2020, col 23 [Commons Chamber] 184 The ‘Rule of Six’ means that, apart from limited exemptions such as work and education, any social gatherings of more than six people will be against the law. For more, see: GOV.UK, Rule of six comes into effect to tackle coronavirus, 14 September 2020 185 National Audit Office, The government’s approach to test and trace in England—interim report, 11 December 2020, page 18 48 Coronavirus: lessons learned to date A few weeks later, the midlands goes into tier 3, so we then keep the midlands at a high level of incidence for the foreseeable future. London is shortly thereafter, and we keep London there. The logical extension of this means that we all end up at a high level of incidence, where hospitals are really under strain and we have large numbers of deaths.
Department for Science, Innovation and Technology
Department of Health and Social Care
Professor Dame Angela McLean, Chief Scientific Adviser to the Ministry of Defence and a participant...
Conclusion · source text
Professor Dame Angela McLean, Chief Scientific Adviser to the Ministry of Defence and a participant of SAGE, told the Science and Technology Committee in February 2021 that the tier system waited until prevalence was high before any action was taken, implying this was a flaw with the tier system: What we did with the tier system was we waited until prevalence—the number of people in a place—was high before putting it into a more restrictive tier. We should have said, “Ah, look, in this part of the country the number of infections is starting to grow”—we have a rather exquisite tool for measuring that—and put it into a higher tier while its prevalence was still low.187 Dame Angela’s point was also noted in SAGE minutes. On 19 November 2020, SAGE said that “evidence shows that the earlier and more rapidly interventions are put in place, and the more stringent they are, the faster the observed reduction in incidence and prevalence.”188
Department for Science, Innovation and Technology
Department of Health and Social Care
Another problem with the tiered restrictions that were implemented during the autumn of 2020 was...
Conclusion · source text
Another problem with the tiered restrictions that were implemented during the autumn of 2020 was that it was not fully clear what criteria would cause a particular area to be placed in a given tier, nor what would be required for it to exit a particular tier. At times, these decisions felt arbitrary and untransparent. The newly-formed Joint Biosecurity Centre was the source of data and analysis on which these important decisions were made. However, the Joint Biosecurity Centre is a particularly opaque organisation, lacking even the transparency that had come to be displayed eventually by SAGE.189 Dr Clare Gardiner, who was appointed Director of the Joint Biosecurity Centre in June 2020 (but who has now resigned from the post) told our inquiry: The sorts of data that we look at are case rates and positivity–the number of people who have tested positive–in different age groups. […] we are also looking keenly at the number of people being admitted to hospital.190
Department for Science, Innovation and Technology
Department of Health and Social Care
There has also been a lack of transparency over the scientific case for particular interventions.
Conclusion · source text
There has also been a lack of transparency over the scientific case for particular interventions. After the initial, broad lockdown had been lifted specific prohibitions were introduced in later months. Such restrictions were typically justified by Ministers as 186 Q164 187 Oral evidence taken before the Science and Technology Committee on 17 February 2021, HC (2019–21) 136, Q1990 188 GOV.UK, SAGE 69, 19 November 2020 189 Science and Technology Committee, First Report of Session 2019–21, The UK response to covid-19: use of scientific advice, HC 136, paragraphs 59–64. We note that since the publication of the Science and Technology Committee’s Report some information has been published by the JBC. Some of this was outlined in DHSC, ‘The Government’s Response to the Science and Technology Committee report: The UK Response to Covid-19: Use of Scientific Advice’, May 2021, CP 432 190 Q184 Coronavirus: lessons learned to date 49 being scientifically based. But supporting scientific reasoning and evidence was usually lacking. For example, no SAGE paper, or scientific evidence, was published to support the imposition from 24 September 2020 of a 10pm curfew on pubs—a decision that affected the livelihoods of many people in the hospitality sector.191
Department for Science, Innovation and Technology
Department of Health and Social Care
Scientific advice was cited in justification for increasingly fine-grained restrictions— with which some of the...
Conclusion · source text
Scientific advice was cited in justification for increasingly fine-grained restrictions— with which some of the Government’s scientific advisers were often visibly uncomfortable. When Sir Patrick Vallance, the Government Chief Scientific Adviser, was asked on 3 November why children’s outdoor sport was banned, despite by then widespread evidence that outdoor transmission of covid was very rare, Sir Patrick said: They have had advice from us in terms of the general principles and some of the areas, but, as I say, not down to individual specific activities like that, and the same is true on the medical side as well. […] Chair: Would you advise that children’s outdoor sports should banned? Sir Patrick Vallance: As Chris said, we just do not go down to that level of individual activities.192
Department for Science, Innovation and Technology
Department of Health and Social Care
The two months between September 2020 and 31 October 2020 were an unsatisfactory period in...
Conclusion · source text
The two months between September 2020 and 31 October 2020 were an unsatisfactory period in which the comparative simplicity of the rules in place from the evening of 23 March onwards were replaced by a complex, inconsistent, shifting and scientifically ambiguous set of detailed restrictions. The rules had previously been a matter of broad national consent, but that sense of national solidarity began to erode, as the uncomfortable stand-off in Greater Manchester showed. Proposed circuit breaker
Department for Science, Innovation and Technology
Department of Health and Social Care
Throughout September and October 2020, case numbers and hospitalisations continued to rise nationwide.
Conclusion · source text
Throughout September and October 2020, case numbers and hospitalisations continued to rise nationwide. As the virus started to spread and a second wave appeared to have started, SAGE advised on 21 September 2020 that a two week ‘circuit breaker’, a short and sharp lockdown, could return incidence to manageable levels.193 However, the Government resisted that advice and continued to take localised action. This was a key moment when the Government significantly diverged from the scientific advice it received. On 24 September 2020, SAGE said: SAGE previously advised that a 2 week ‘circuit-breaker’, where more stringent restrictions are put in place for a shorter period, could have additional impact. A shorter break of a week or less is likely to be less effective in reducing the number of infections and slowing the growth of the epidemic. 191 GOV.UK, ‘News story: Coronavirus (COVID-19): What has changed – 22 September’, accessed 17 August 2021. See also: Letter from the Chair of the Science and Technology Committee to Sir Patrick Vallance, Government Chief Scientific Adviser, dated 30 September 2020, and Sir Patrick’s response dated 13 October 2020; and Letter from the Chair of the Science and Technology Committee to the Secretary of State for Health and Social Care, Matt Hancock MP, dated 13 October 2020, and the Secretary of State’s response dated 16 October 2020. 192 Oral evidence taken before the Science and Technology Committee on 3 November 2020, HC (2019–21) 136, Qq1538–39 193 GOV.UK, SAGE 57, 17 September 2020 50 Coronavirus: lessons learned to date However, while a single circuit breaker has the potential to keep prevalence much lower than no intervention, it is not a long-term solution. Long-term control of the virus will likely require repeated circuit breaks, or for one to be followed by a longer-term period with measures in place to keep R at or below 1. Longer-term sustained measures will also be essential.194
Department for Science, Innovation and Technology
Department of Health and Social Care
In evidence to the Science and Technology Committee in November 2020, Sir Patrick Vallance added...
Conclusion · source text
In evidence to the Science and Technology Committee in November 2020, Sir Patrick Vallance added that the intention of the circuit breaker was to enable the test and trace system—which in September had once again been found to be inadequate—to be more effective: The advice in September was about a circuit breaker with the intention of driving the numbers back to how they were in August, going back to the discussion on test and trace, because that means you have a greater chance of test and trace being effective. That takes more of the load in managing the disease and you may have to do fewer in terms of other non-pharmaceutical interventions. That is the logic behind that suggestion […].195 Professor Chris Whitty suggested that the case for a circuit breaker was not conclusive, reflecting “there is a lot of uncertainty in these things.”196
Department for Science, Innovation and Technology
Department of Health and Social Care
Dominic Cummings told our inquiry that Downing Street held a meeting on 20 September 2020...
Recommendation · source text
Dominic Cummings told our inquiry that Downing Street held a meeting on 20 September 2020 for the Prime Minister to hear both sides of the argument. He explained that Professor John Edmunds put forward the view that the Government should impose another lockdown while Professors Gupta and Heneghan put forward an opposing view. Professor Gupta and Professor Heneghan have subsequently written to us to highlight their view regarding that meeting, including, in their view, that a number of claims that Dominic Cummings made about their presentation to the Prime Minister were incorrect.197 Following that meeting, Mr Cummings explained that the Prime Minister was not persuaded about the need to impose another national lockdown.198
Department for Science, Innovation and Technology
Department of Health and Social Care
It is impossible to know whether a circuit breaker would have had a material effect...
Conclusion · source text
It is impossible to know whether a circuit breaker would have had a material effect in preventing a second lockdown, given that such an approach was pursued in Wales, which still ended up having further restrictions in December 2020. But it seems that Ministers were mistaken in the weeks after the first wave abated in taking an optimistic assumption that the worst was behind us.199 The second lockdown
Department for Science, Innovation and Technology
Department of Health and Social Care
On 31 October 2020, the Prime Minister announced tougher nationwide restrictions in England—the second lockdown.200...
Conclusion · source text
On 31 October 2020, the Prime Minister announced tougher nationwide restrictions in England—the second lockdown.200 The UK public were once again told to “stay at 194 GOV.UK, SAGE 59, 24 September 2020 195 Oral evidence taken before the Science and Technology Committee on 3 November 2020, HC (2019–21) 136, Q1505 196 Oral evidence taken before the Science and Technology Committee on 3 November 2020, HC (2019–21) 136, Q1507 197 Professor Carl Heneghan (Director at Centre for Evidence-Based Medicine, Professor of Evidence-Based Medicine at University of Oxford); Professor Sunetra Gupta (Professor of Theoretical Epidemiology at University of Oxford) (CLL0117)) 198 Q1154 199 For example, the changing advice on working from home, the ‘eat out to help out’ scheme and Q1093. 200 GOV.UK, ‘Prime Minister’s statement on coronavirus (COVID-19): 31 October 2020’, accessed 17 September 2021 Coronavirus: lessons learned to date 51 home”. However, unlike the first lockdown, schools remained open. The Prime Minister announced the second lockdown to the House of Commons on 2 November (having announced it to the nation on 31 October), where he imposed a clear time limit on the lockdown: Let me stress that these restrictions are time limited. After four weeks, on Wednesday 2 December, they will expire, and we intend to return to a tiered system on a local and regional basis, according to the latest data and trends.201 On 2 December 2020, the second lockdown ended, and England went back into the three- tier system. However, case numbers remained high (at 14,879 on 3 December 2020)202 and started rising again. As a result, on 19 December 2020, the Prime Minister added a tier 4 to the tiering system.203 This followed the discovery of the new UK variant (B.1.1.7) of covid-19, or the “Alpha” variant.
Department for Science, Innovation and Technology
Department of Health and Social Care
The circumstances of the lockdown announced on 31 October were controversial.
Conclusion · source text
The circumstances of the lockdown announced on 31 October were controversial. A Downing Street press conference had been hastily convened on the Saturday evening following leak to newspapers of the Government’s likely intention to bring in a further lockdown.
Department for Science, Innovation and Technology
Department of Health and Social Care
At the press conference, modelling projections were presented which warned of a risk to the...
Conclusion · source text
At the press conference, modelling projections were presented which warned of a risk to the ability of the NHS to cope with likely hospital admissions unless the proposed measures were taken. Sir Patrick Vallance in evidence to the Science and Technology Committee on 3 November said: You would expect the number of hospitalisations to breach the first wave probably towards the end of November. You would expect the number of deaths, potentially, to equal, the first wave numbers sometime in mid- December.204
Department for Science, Innovation and Technology
Department of Health and Social Care
However, it emerged during the following days that the modelling that was presented at the...
Conclusion · source text
However, it emerged during the following days that the modelling that was presented at the press conference was based on data that had been superseded by more up-to-date information. It also emerged that the forecasts did not include the impact of the regional restrictions that had been brought in on 9 October.205 In practice, the advice of the Government’s most senior scientific advisers that the NHS was likely to be overwhelmed if the advised second lockdown was not imposed made it almost inevitable that it would go ahead: Chair: We come to the importance of the inquiries into these forecasts. Accepting that Ministers decide and advisers advise, in practice, if the advice from advisers to the Prime Minister is that the capacity of the NHS is likely to be overrun within weeks, that is quite difficult advice to gainsay, is it not? That is why there is an interest in understanding the basis of the advice. It is not optional advice in that sense, is it? 201 HC Deb, 2 November 2020, col 24 [Commons Chamber] 202 GOV.UK, ‘Coronavirus (COVID-19) in the UK’, accessed 22 June 2021 203 GOV.UK, ‘Prime Minister’s statement: 19 December 2020’, accessed 17 September 2021 204 Oral evidence taken before the Science and Technology Committee on 3 November 2020, HC (2019–21) 136, Q1438 205 See, for example: Correspondence from Ed Humpherson to Sir Patrick Vallance regarding transparency of data related to COVID-19, 5 November 2020 52 Coronavirus: lessons learned to date Sir Patrick Vallance: That was the forecasting from the NHS. That is what they said. Chair: It is also what you said. Sir Patrick Vallance: Yes. It is what we say from the modelling. As I said, we cannot deal with NHS capacity. I do not have insight into NHS capacity. Chair: But your advice to the Prime Minister and the Government, based on NHS data and the modelling data, was that this is a serious prospect and a serious risk. Sir Patrick Vallance: Yes.206 The Kent or ‘Alpha’ variant
Department for Science, Innovation and Technology
Department of Health and Social Care
Whilst it is clear the first lockdown was called too late, it is not however...
Conclusion · source text
Whilst it is clear the first lockdown was called too late, it is not however possible to make such a clear cut judgement about the second lockdown from 31 October for two reasons. First, since the advice was taken and lockdown measures were introduced, the counterfactual—what would have happened to infections, hospital admissions and deaths if the second lockdown had not been instigated—is unknowable. The second reason is that unknown to advisers at the time, a new variant of covid (B.1.1.7) which came to be described first as the Kent variant and later as the Alpha variant, was already transmitting within the population. We were eventually to learn that this variant was significantly more transmissible than the initial strain of covid-19.
Department for Science, Innovation and Technology
Department of Health and Social Care
Following genomic sequencing, PHE found that the Alpha variant first appeared in Kent in September...
Conclusion · source text
Following genomic sequencing, PHE found that the Alpha variant first appeared in Kent in September 2020 and rapidly became the dominant variant in Kent, and subsequently, the rest of England.207 The new variant was first brought to the attention of the Government on 11 December 2020.208 On 18 December, the Government was warned that the variant was significantly more transmissible than the initial strain of covid-19.209 The eventual knowledge of this new variant and its heightened transmissibility explained what had been observed earlier: that North Kent and neighbouring areas were experiencing unaccountably high and persistent levels of covid infections during the late autumn. For example, on 30 November 2020, the rate of confirmed covid-19 cases in Swale, in North Kent, was 568 per 100,000 population—over three times as high as the UK rate of 154 per 100,000.210
Department for Science, Innovation and Technology
Department of Health and Social Care
Leading virologists who gave evidence to the Science and Technology Committee on 23 December said...
Conclusion · source text
Leading virologists who gave evidence to the Science and Technology Committee on 23 December said that the Government had acted quickly in response to the new evidence. For example, Professor Peter Horby, Chair of the New and Emerging Respiratory Virus 206 Oral evidence taken before the Science and Technology Committee on 3 November 2020, HC (2019–21) 136, Qq1443–1445 207 GOV.UK, ‘COVID-19 (SARS-CoV-2): information about the new virus variant’, accessed 17 September 2021 208 Susan Hopkins, Strategic Response Director, COVID-19, PHE, explained in a media interview on 20 December that the Government was first notified of the new variant on 11 December: @RidgeonSunday Twitter, 20 December 2020, 12.53pm 209 Following work by modellers and academics, Dr Susan Hopkins explained to The Andrew Marr Show on 20 December that, a difference in transmissibility and infectiousness was identified and the Government was notified of this on 18 December and “immediately started to take action”: BBC One, ‘Professor Susan Hopkins on the new coronavirus variant’, accessed 17 August 2021. 210 GOV.UK, ‘Coronavirus (COVID-19) in the UK’, web archive, accessed 17 August 2021 Coronavirus: lessons learned to date 53 Threats Advisory Group (NERVTAG),211 gave a positive assessment of the timeliness of Government action on the new variant: “We sent our first note to them raising a significant concern on the 18th, and on the 19th measures were put in place.”.212 The Government moved to cancel most of the previously announced relaxations of restrictions at Christmas, and thereafter introducing a third national lockdown from 6 January 2021.213
Department for Science, Innovation and Technology
Department of Health and Social Care
The second wave of the pandemic was more numerous in terms of hospital admissions and...
Conclusion · source text
The second wave of the pandemic was more numerous in terms of hospital admissions and deaths than the first wave. It peaked on 8 January 2021 with 68,053 new infections per day reported in the UK,214 and on 20 January with 1,820 deaths.215 This wave was dominated by the Alpha variant. The Alpha variant was dominant at the time of the peak infections and deaths, and had represented over 50% of UK covid infections from 4 January 2021.216 Of the total deaths during second wave,217 56.9% took place after the Alpha variant was the dominant form.
Department for Science, Innovation and Technology
Department of Health and Social Care
Due to the much higher transmissibility of the Alpha variant, in the absence of a...
Conclusion · source text
Due to the much higher transmissibility of the Alpha variant, in the absence of a test, trace and isolate system capable of arresting the spread of the virus, a circuit-breaker in September and an earlier, more stringent lockdown, would likely have reduced deaths. Had more stringent social distancing measures been adopted during the autumn they could have reduced the seeding of the Alpha variant across the country, slowed its spread and therefore have saved lives. However, this is something we know now, but was not knowable at the time lockdown decisions were taken during the autumn: the existence of the Alpha variant was known only in December 2020.
Department for Science, Innovation and Technology
Department of Health and Social Care
But these decisions were taken before the existence of the Alpha variant was known.
Conclusion · source text
But these decisions were taken before the existence of the Alpha variant was known. So the justification for an earlier lockdown is greatly influenced by information that was not available at the time. It serves to illustrate that, in a pandemic whose course is unknown, some decisions will be taken which turn out to have been wrong, but which it was not possible to know at the time. Public health messaging and communication
Department for Science, Innovation and Technology
Department of Health and Social Care
Several public health experts stressed to us that an effective messaging and communications strategy was...
Recommendation · source text
Several public health experts stressed to us that an effective messaging and communications strategy was a crucial part of the response to a pandemic. In July 2020, Sir Paul Nurse argued in evidence to the Health and Social Care Committee that “communication, messaging and keeping trust” should be one of the core focuses of the Government’s strategy.218 This was echoed by Sir Jeremy Farrar, who explicitly linked consistent messaging to public compliance with other NPIs: 211 NERVTAG is an expert committee of the Department of Health and Social Care (DHSC), which advises the Chief Medical Officer (CMO) and, through the CMO, Ministers, DHSC and other Government departments. 212 Oral evidence taken before the Science and Technology Committee on 23 December 2020, HC (2019–21) 136, Q1612 213 GOV.UK, ‘Prime Minister’s statement on coronavirus (COVID-19): 19 December 2020’, and HC Deb, 6 January 2021, cols 734–736 [Commons Chamber] 214 GOV.UK, ‘Cases in the UK: Coronavirus in the UK—cases by date reported’, accessed 17 August 2021 215 GOV.UK, ‘Deaths in the UK: Coronavirus in the UK—Deaths within 28 days of positive test by date reported’, accessed 17 August 2021 216 Ourworldindata, SARS-CoV-2 variants in analyzed sequences, United Kingdom, accessed 2 September 2021 217 According to the Office for National Statistics, the second wave was estimated to be between 7 September 2020 to 24 April 2021. 218 Oral evidence taken before the Health and Social Care Committee on 21 July 2020, HC (2019–2021) 36, Q589 54 Coronavirus: lessons learned to date Consistent messaging and trust in the messaging is absolutely vital. If you are asking anybody—the community or the public—to do things that they would not normally do, they have to trust the message and the messenger, and that has to be consistent over time.219
Department for Science, Innovation and Technology
Department of Health and Social Care
At the outset of the pandemic, the Prime Minister’s “stay at home” order was accompanied...
Conclusion · source text
At the outset of the pandemic, the Prime Minister’s “stay at home” order was accompanied by a public messaging campaign that clearly instructed the public to “stay home, protect the NHS, save lives”. This message was driven by regular televised press conferences from Number 10 Downing Street, during which Ministers sought to emphasise that the response was “built upon the bedrock of the best possible scientific and medical advice”.220 Professor Whitty credited this initial messaging as “absolutely essential in people understanding what needed to happen, and then doing it.”221 The message was clear in both the instruction it was giving the public, as well as plainly explaining why they were being asked to change their behaviour.
Department for Science, Innovation and Technology
Department of Health and Social Care
Much of the evidence to our inquiry has acknowledged that this “Stay at Home” slogan...
Conclusion · source text
Much of the evidence to our inquiry has acknowledged that this “Stay at Home” slogan was successful in fostering sufficient levels of awareness and understanding among the public. For example, during this period there was a marked fall in the number of people travelling on the roads and using recreational areas. Written evidence from the Nuffield Trust attributed this apparent success to the “simplicity and ease of recall” of the message.222 According to Professor Devi Sridhar, Chair of Global Public Health at the University of Edinburgh, the public are more likely to comply with instructions that are clear and easy to understand: You have to take the public with you. The public will comply, not because they are forced to, or because there is military on the streets, but because they want to. People generally want to follow the rules if they understand them.223
Department for Science, Innovation and Technology
Department of Health and Social Care
Evidence from University College London (UCL) showed that during the first lockdown, the simplicity and...
Conclusion · source text
Evidence from University College London (UCL) showed that during the first lockdown, the simplicity and clarity of public health messaging did indeed translate into high levels of compliance with the stay at home order. According to UCL, during this period “levels of understanding were reported by individuals to be very high” and simultaneously “over 70% of [70,000] survey respondents reported ‘complete compliance’ with guidelines”.224
Department for Science, Innovation and Technology
Department of Health and Social Care
Although the communications strategy in the initial phase of the pandemic was broadly successful, it...
Conclusion · source text
Although the communications strategy in the initial phase of the pandemic was broadly successful, it is worth noting that there was some confusion over who the stay at home order applied to, and there was criticism of the Government’s decision not to provide a British Sign Language (BSL) interpreter on-set at the televised briefings. Similar briefings in Scotland and Wales did include an interpreter, socially distanced from Ministers. In the UK, there are more than 80,000 Deaf people whose first language is BSL.225 The decision not 219 Oral evidence taken before the Health and Social Care Committee on 21 July 2020, HC (2019–2021) 36, Q585 220 GOV.UK, Health and Social Care Secretary’s statement on coronavirus (COVID-19), 5 April 2020. 221 Q827 222 Nuffield Trust (CLL0087) 223 Oral evidence taken before the Health and Social Care Committee on 21 July 2020, HC (2019–2021) 36, Q584 224 University College London (CLL0023) 225 Equality and Human Rights Commission, Letter to the Prime Minister, April 2020. Coronavirus: lessons learned to date 55 to include an interpreter at these briefings, where important public health announcements were often made, may have reduced their ability to understand the messages provided and in turn potentially decreased trust and compliance among this group.
Department for Science, Innovation and Technology
Department of Health and Social Care
On 10 May 2020, the Government announced that society would begin to reopen in England...
Conclusion · source text
On 10 May 2020, the Government announced that society would begin to reopen in England through a staged series of lockdown easing measures.226 From this point, there were divergent approaches to messaging across the four nations of the UK. To reflect the gradual lifting of strict lockdown measures in England, the Government changed its slogan from “stay home, protect the NHS, save lives” to “stay alert, control the virus and save lives”.227 In contrast, during a press conference on the same day, the First Minister of Scotland emphasised that “we remain in lockdown for now and my ask of you remains to Stay at Home”.228
Department for Science, Innovation and Technology
Department of Health and Social Care
Written evidence to our inquiry suggested that the loss of consistency across the four nations...
Conclusion · source text
Written evidence to our inquiry suggested that the loss of consistency across the four nations led to confusion, with “messages from numerous national bodies that, at times, appeared to contradict each other”.229 We heard that at this stage, these contradicting messages began to cause confusion. Professor Devi Sridhar, speaking to the Health and Social Care Committee in July 2020, explicitly linked this confusion to infection rates: One point where you can see that England and Scotland diverged was when England changed in May to: “Stay alert.” Many people did not fully understand what that meant. In Scotland, the message was very clear: “Stay at home.” When we started to see divergence in infection rates and death rates, it was around that time.230
Department for Science, Innovation and Technology
Department of Health and Social Care
The three-tier approach to local lockdown restrictions in England (see paragraph 117) introduced more complexity...
Conclusion · source text
The three-tier approach to local lockdown restrictions in England (see paragraph 117) introduced more complexity to Government messaging which was, understandably different in different parts of the country.231 It was therefore unsurprising that this more differentiated messaging strategy meant that levels of public understanding and compliance began to deteriorate. Written evidence submitted by UCL showed much poorer comprehension of the rules than at the beginning of the pandemic. By October, fewer than half of the over 70,000 adults who took part in the survey reported broad understanding of the rules (45%), with just 14% understanding them ‘very much’. Self- reported compliance was consequently also much lower, with just over 40% reporting ‘complete compliance’ with guidelines, compared to 70% earlier in the pandemic.232
Department for Science, Innovation and Technology
Department of Health and Social Care
Written evidence suggested that the inconsistency in Government messaging after the first wave of the...
Conclusion · source text
Written evidence suggested that the inconsistency in Government messaging after the first wave of the pandemic was also damaging to public trust in official information.233 Analysis submitted by Leeds Beckett University showed that most members of the public did not trust information from the UK Government and that they were much more likely to trust information shared by the World Health Organisation.234 The perception that key Government figures, including the former assistant to the Prime Minister, had breached lockdown rules may have further undermined public trust during spring 2020. In oral 226 GOV.UK, ‘Prime Minister’s Statement on coronavirus (COVID-19): 10 May 2020’, accessed 17 September 2021 227 GOV.UK, ‘Prime Minister’s Statement on coronavirus (COVID-19): 10 May 2020’, accessed 17 September 2021 228 Gov.scot, ‘Coronavirus update: First Minister’s speech: 10 May 2020’, accessed 17 September 2021 229 Association of Anaesthetists (CLL0014) 230 Oral evidence taken before the Health and Social Care Committee on 21 July 2020, HC (2019–2021) 36, Q584 231 GOV.UK, ‘Prime Minister announces new local COVID Alert Levels: 12 October 2020’, accessed 17 September 2021 232 University College London (CLL0023) 233 For example, see: Nuffield Trust (CLL0087) 234 Leeds Beckett University (CLL0003) 56 Coronavirus: lessons learned to date evidence, Dominic Cummings acknowledged that his widely reported trip to Durham was “a complete disaster” and admitted that it “undermined public confidence in the whole thing”.235
Department for Science, Innovation and Technology
Department of Health and Social Care
Lower levels of public trust and understanding of the regulations also created a gap into...
Conclusion · source text
Lower levels of public trust and understanding of the regulations also created a gap into which misinformation was able to spread. Research conducted by Ofcom in the first six weeks of the pandemic found that 47% of respondents said they had come across false or misleading information about covid-19 in the last week. Most commonly, respondents indicated that the misinformation they encountered was linked to “theories linking the origins or causes of covid-19 to 5G technology”.236 More recently, a study conducted by King’s College London in November 2020 found that 14% of respondents “believe the real purpose of a mass vaccination programme against coronavirus is simply to track and control the population”.237 Susceptibility to covid-19 misinformation has many causes, but research has found that lower levels of trust in both scientists and Government are associated with increased susceptibility to misinformation.238 This highlights the critical importance of a communications strategy which is clear, consistent and perceived as transparent by the public. Outcomes
Department for Science, Innovation and Technology
Department of Health and Social Care
The covid pandemic is a global emergency that is not yet over.
Conclusion · source text
The covid pandemic is a global emergency that is not yet over. While the UK’s trajectory may have changed in recent months with vaccines, the vast majority of the world is still grappling with the disease. It would be prudent to reserve judgement on the UK’s performance until the pandemic is over across the world. When that time comes, we will be able to more accurately and fairly judge the UK’s performance against the rest of the world.
Department for Science, Innovation and Technology
Department of Health and Social Care
One of the key ways to measure a country’s success in fighting covid-19 is to...
Conclusion · source text
One of the key ways to measure a country’s success in fighting covid-19 is to measure deaths from covid-19. However, countries across the world measure deaths in different ways. The UK has reported covid deaths as those who died within 28 days of a positive test. The UK also offers statistics on daily deaths with covid-19 on the death certificate. The US Centres for Disease Control includes both confirmed and probable cases and deaths.239 The historian, Professor Niall Ferguson, told the House of Commons Foreign Affairs Committee: I actually think there is a better way of looking at this, which is to look at excess mortality. We don’t have excess mortality data for all the countries in the world, but if you look at the ones for which we do have data, the UK and the US are firmly in the middle of the table, with 17% or 18% excess mortality, close to Belgium, close to Italy, close to Spain. 235 Q1115 236 Ofcom, ‘covid-19 news and information: consumption and attitudes- previous results’, accessed 17 September 2021 237 Kings College London, Coronavirus: vaccine misinformation and the role of social media, December 2020 238 See, for example: The Royal Society, Susceptibility to misinformation about COVID-19 around the world, October 2020; The Royal Society, COVID-19 vaccine deployment: Behaviour, ethics, misinformation and policy strategies, October 2020 239 CDC, ‘United States COVID-19 Cases and Deaths by State over Time’, accessed 17 September 2021 Coronavirus: lessons learned to date 57 Some countries in Europe did slightly better—France, Sweden, Switzerland— but there are a great many countries that did a good deal worse. I won’t recap the countries you are expecting to hear—once again, it is Latin American and east European countries that have the worst excess mortality. Of course, some countries in Europe have done significantly better, to the point, in the case of Denmark, of having no excess mortality, or virtually none in Norway. I think this is probably the be
Department for Science, Innovation and Technology
Department of Health and Social Care
There are also other factors to be considered.
Conclusion · source text
There are also other factors to be considered. Each country has a unique set of characteristics which might have contributed to its health related covid-19 outcomes. For example, the UK has the tenth-highest rate of obesity in the world,241 which is linked to an increased risk of adverse outcomes.242 Conclusions and recommendations Conclusions
Department for Science, Innovation and Technology
Department of Health and Social Care
During the first three months of the covid pandemic, the UK followed the wrong policy...
Conclusion · source text
During the first three months of the covid pandemic, the UK followed the wrong policy in its use of non-pharmaceutical interventions. When the UK moved from the ‘contain’ to ‘delay’ stage, there was a policy of seeking to only moderate the speed of infection through the population—flattening the curve—rather than seeking to arrest its spread. The policy was pursued until 23 March because of the official scientific advice the Government received, not in spite of it. Questions remain about whether the containment phase was pursued aggressively enough—we believe it could have been pursued for longer. During this period Government policy did not deviate from the scientific advice it received in any material respect. The fact that the UK approach reflected a consensus between official scientific advisers and the Government indicates a degree of groupthink that was present at the time which meant we were not as open to approaches being taken elsewhere—such as earlier lockdowns, border controls and effective test and trace—as we should have been.
Department for Science, Innovation and Technology
Department of Health and Social Care
The flattening the curve policy was implemented by introducing new restrictions only gradually and slowly,...
Conclusion · source text
The flattening the curve policy was implemented by introducing new restrictions only gradually and slowly, acting as if the spread of the virus were susceptible to calibrated control. Modelling at the time suggested that to suppress the spread of covid-19 too firmly would cause a resurgence when restrictions were lifted. This was thought likely to result in a peak in the autumn and winter when NHS pressures were already likely to be severe. In addition, it was thought that the public would only comply with severe restrictions for a limited period, and so those restrictions should not be applied before they were most needed. This approach should have been questioned at the time for a number of reasons: 240 Oral evidence taken before the Foreign Affairs Select Committee on 22 June 2021, HC (2021–22) 200, Q134 241 OECD, Obesity Update, 2017 242 GOV.UK, Disparities in the risk and outcomes of COVID-19, August 2020 58 Coronavirus: lessons learned to date • it entailed people contracting covid in large numbers with hundreds of thousands of deaths likely to result; • other countries, in Asia and in Europe, including some with experience of SARS and MERS, had chosen to implement earlier, more comprehensive strategies of non-pharmaceutical interventions, which were having success; and • suppressing the spread of the virus in the early period would have bought valuable time to consider what was the best way to manage the pandemic in the medium term.
Department for Science, Innovation and Technology
Department of Health and Social Care
There are several possible explanations for what was a significant error in policy and advice...
Conclusion · source text
There are several possible explanations for what was a significant error in policy and advice early in the pandemic. These include: • the lack of adequate data on the spread of covid-19, as a result of the inadequacy of the UK testing operation; • overreliance on specific mathematical models when there were too many uncertainties; • assumptions about public compliance with rules that turned out to have underestimated the willingness to conform even for long periods; • the composition of SAGE suffered from a lack of representation from outside the United Kingdom; and • a preference for a particular UK approach may have been favoured above advice based on emulation of what was being pursued elsewhere.
Department for Science, Innovation and Technology
Department of Health and Social Care
Science proceeds through challenge and disputation, and new theories are tested unflinchingly against evidence.
Conclusion · source text
Science proceeds through challenge and disputation, and new theories are tested unflinchingly against evidence. Yet Ministers and other advisers reported that they felt it difficult to challenge the views of their official scientific advisers. Those in Government have a duty to question and probe the assumptions behind any scientific advice given, particularly in a national emergency, but there is little evidence sufficient challenge took place. However, even when UK policy had changed to bring in a comprehensive national lockdown, the role of non-pharmaceutical interventions against covid-19 was complex, inconsistent and opaque for most of the rest of 2020.
Department for Science, Innovation and Technology
Department of Health and Social Care
The second wave of covid infections, hospitalisations and deaths during the autumn and winter of...
Conclusion · source text
The second wave of covid infections, hospitalisations and deaths during the autumn and winter of 2020/21 was significantly driven by the emergence of a new variant, known as the Kent or Alpha variant. It is likely that a “circuit break” of temporary lockdown measures if introduced in September 2020, and earlier lockdown measures during the winter, could have impeded the rapid seeding and spread of the Kent variant. However, the existence of the Kent or Alpha variant was not known by the Government until 11 December 2020 so that the justification for taking earlier measures could not rely on information available at the time.
Department for Science, Innovation and Technology
Department of Health and Social Care
Government public health communications are key to the public’s understanding of and compliance with non-pharmaceutical...
Conclusion · source text
Government public health communications are key to the public’s understanding of and compliance with non-pharmaceutical interventions. Initial messaging from the Government early in the pandemic was strong, effective and undoubtedly contributed to the success of the first lockdown. After the gradual lifting of the first lockdown Coronavirus: lessons learned to date 59 from May 2020, Government guidance became increasingly complex and harder to understand, with restrictions varying in different parts of the country. Government communications did not always reflect this nuance, leading to perceived inconsistency and divergent strategies across the four nations of the UK. Recommendations and lessons learned
Department for Science, Innovation and Technology
Department of Health and Social Care
In the early days of a crisis, scientific advice may be necessarily uncertain: data may...
Conclusion · source text
In the early days of a crisis, scientific advice may be necessarily uncertain: data may be unavailable, knowledge limited and time may be required for analysis to be conducted. In these circumstances it may be appropriate to act quickly, on a precautionary basis, rather than wait for more scientific certainty.
Department for Science, Innovation and Technology
Department of Health and Social Care
In future an approach of greater questioning and challenge should characterise the development of policy.
Recommendation · source text
In future an approach of greater questioning and challenge should characterise the development of policy. Ministers should have the confidence to follow a scientific approach themselves—being prepared to take a more robust approach to questioning and challenging the advice given. The Government and SAGE should also facilitate strong external and structured challenge to scientific advice, including from experts in countries around the world, and a wider range of disciplines.
Department for Science, Innovation and Technology
Department of Health and Social Care
In bringing together many of the UK’s most accomplished scientists, SAGE became a very UK...
Recommendation · source text
In bringing together many of the UK’s most accomplished scientists, SAGE became a very UK body. In future, it should include more representation and a wider range of disciplines, from other countries, especially those which have experienced, or are experiencing, the same emergency.
Department for Science, Innovation and Technology
Department of Health and Social Care
In a pandemic, the scientific advice from the SAGE co-chairs to the Government should be...
Recommendation · source text
In a pandemic, the scientific advice from the SAGE co-chairs to the Government should be published within 24 hours of it being given, or the policy being decided, whichever is the later, to ensure the opportunity for rapid scientific challenge and guard against the risk of ‘groupthink’. In addition, minutes and SAGE papers should be published within 48 hours of the meeting taking place.
Department for Science, Innovation and Technology
Department of Health and Social Care
The Government, via the World Health Organisation, should make the case for an international standard...
Recommendation · source text
The Government, via the World Health Organisation, should make the case for an international standard of reporting covid-19 deaths and a framework for reporting disease related deaths for future pandemics. 60 Coronavirus: lessons learned to date 4 Testing and contact tracing
Department for Science, Innovation and Technology
Department of Health and Social Care
While, as we will illustrate in Chapter 7, the UK’s vaccination programme has been a...
Conclusion · source text
While, as we will illustrate in Chapter 7, the UK’s vaccination programme has been a national success, the record during the pandemic of the test, trace and isolate programme is more mixed. The slow, uncertain, and often chaotic performance of the test, trace and isolate system during the first phases of the pandemic was a drag anchor on the UK’s response to the pandemic. Partly because NHS Test and Trace was only established when daily infections had risen to 2,000, it ultimately failed in its objective to prevent future lockdowns despite vast quantities of taxpayers’ money being directed to it.243 In contrast to the approach to vaccines, which we discuss in greater detail in Chapter 7, NHS Test and Trace had to build a new organisation and respond to changing circumstances while it was operating rather than being able to anticipate these in advance of the system being in operation. In this Chapter, when we refer to NHS Test and Trace we refer to the new organisation set up by the Department of Health and Social Care, initially led by Baroness Harding, in partnership with several public and private organisations.
Department for Science, Innovation and Technology
Department of Health and Social Care
This Chapter looks at a number of different facets of the test, trace and isolate...
Conclusion · source text
This Chapter looks at a number of different facets of the test, trace and isolate system— though they are illustrative rather than exhaustive. While it describes an unsatisfactory history, there are signs that the UK has now arrived at a more dependable outcome: the UK now has, in principle, the ability to test more than 800,000 people a day, and in the week commencing 23 August 2021 there were more than 5.6 million tests carried out in England, more than any EU/EEA country.244 But there are many lessons to be learned on the way and this notional capacity has yet to be fully tested in action.
Department for Science, Innovation and Technology
Department of Health and Social Care
In this Chapter we consider in particular: • the initial testing capacity available; • the...
Conclusion · source text
In this Chapter we consider in particular: • the initial testing capacity available; • the decision to abandon testing in the community; • the 100,000 tests a day target introduced by the then Secretary of State; • the centralisation of testing laboratories; • the shortage of testing capacity in Autumn 2020; • the organisation of contact tracing; and • the management of “NHS” Test and Trace. Limited testing capacity
Department for Science, Innovation and Technology
Department of Health and Social Care
During the early days of the pandemic, the Government believed—and told the public—that testing for...
Conclusion · source text
During the early days of the pandemic, the Government believed—and told the public—that testing for covid-19 was a field in which the UK had a leading position. This assessment was shared, and possibly arose out of, the views of scientific advisers. The minutes of the very first SAGE meeting on covid-19 on 22 January 2020 stated: 243 On 2 April 2020, when the Government announced its new 5-pillar testing strategy, 4,522 Covid-19 cases were recorded. 244 GOV.UK, ‘Coronavirus in the UK: Testing’; European Centre for Disease Prevention and Control, ‘Data on testing for COVID-19 by week and country’. Coronavirus: lessons learned to date 61 The UK currently has good centralised diagnostic capacity for WN-CoV [covid-19]–and is days away from a specific test, which is scalable across the UK in weeks.245 The following day, on 23 January 2020, the then Secretary of State for Health and Social Care told the House that the UK is “one of the first countries to have developed a world-leading test for the new coronavirus.”246 When the Prime Minister claimed to have “growing confidence that we will have a test, track and trace operation that will be world-beating,” it may be that this early lead was what he had in mind.247 However, it rapidly became apparent that the scientific expertise in identifying the virus and the ability to deploy that operationally were very different. Public Health England was initially responsible for managing covid-19 testing as well as the scientific development of a test for covid-19, but it is in the former that its deficiencies were exposed.
Department for Science, Innovation and Technology
Department of Health and Social Care
SAGE minutes from 28 January 2020 recorded that notwithstanding the scientific lead in establishing a...
Conclusion · source text
SAGE minutes from 28 January 2020 recorded that notwithstanding the scientific lead in establishing a test, PHE only had operational capacity to administer “400 to 500 tests per day” for the whole country.248 Other countries such as South Korea and Hong Kong, who did not benefit from our lead in producing a test, nevertheless rapidly developed a testing capacity to allow a comprehensive testing programme to be put in place during the early weeks of the pandemic.249 By contrast, during the whole, crucial, period between 25 January and 11 March 2020, in which the virus was spreading across the whole country, only 27,476 coronavirus tests were performed in the UK.250 To put this in context, that is less than one test a day for each parliamentary constituency.
Department for Science, Innovation and Technology
Department of Health and Social Care
Professor Martin explained to us that early in the pandemic there were “very severe constraints...
Conclusion · source text
Professor Martin explained to us that early in the pandemic there were “very severe constraints in equipment and consumables” which acted as a drag on testing capacity: Bear in mind that those were all new tests coming on stream at the beginning of the pandemic. Effectively, there was not enough to go round. It was global; it was not just the UK. There was a global shortage of the consumables. […] There are big international suppliers that have capped the UK supply of consumables251
Department for Science, Innovation and Technology
Department of Health and Social Care
However, throughout the pandemic, our Committees have taken a great interest in what might be...
Conclusion · source text
However, throughout the pandemic, our Committees have taken a great interest in what might be learned and applied from how other countries tackled the virus. In March 2020, the World Health Organisation recommended that nations “plan for surge capacity by establishing decentralized testing capacity in sub-national laboratories”.252 Dr Seon Kui Erica Lee, of the Korea Centers for Disease Control and Prevention, told the Science and Technology Committee in April 2020 that testing capacity in the Republic of Korea had expanded rapidly because of lessons learned from the 2015 MERS outbreak.253 Dr 245 GOV.UK, SAGE 1, 22 January 2020 246 HC oral statement, 23 January 2020, Vol 670 [Commons Chamber] 247 HC oral questions, 20 May 2020, Vol 676 [Commons Chamber] 248 GOV.UK, SAGE 2, 28 January 2020 249 See, for example: oral evidence taken before the Health and Social Care Committee on 19 May 2020, HC (2019– 21) 36 and oral evidence taken before the Science and Technology Committee on 16 April 2020, HC (2019–21) 136 250 Department of Health and Social Care, via Twitter, 11 March 2020 251 Q343 252 World Health Organisation, ‘Laboratory testing strategy recommendations for COVID-19: interim guidance: 23 March 2020’, accessed 17 September 2021 253 Oral evidence taken before the Science and Technology Committee on 8 April 2020, HC (2019–21) 136, Q145 62 Coronavirus: lessons learned to date Max Roser also explained to us that “by mid-March [2020], Germany was testing 50,000 people per day”, whilst the UK was “very late” and reached the same capacity one and a half months later.254
Department for Science, Innovation and Technology
Department of Health and Social Care
In evidence to the Science and Technology Committee on 25 March 2020 Public Health England...
Conclusion · source text
In evidence to the Science and Technology Committee on 25 March 2020 Public Health England claimed to have formally studied, but rejected, the South Korean approach.255 Despite repeated requests by the Committee no evidence of such an evaluation has ever been produced. We must conclude that no formal evaluation took place which amounts to an extraordinary and negligent omission given Korea’s success in containing the pandemic which was well-publicised at the time.
Department for Science, Innovation and Technology
Department of Health and Social Care
As a result the UK squandered a leading position in diagnostics and converted it into...
Conclusion · source text
As a result the UK squandered a leading position in diagnostics and converted it into one of permanent crisis. On 12 March, testing for covid-19 other than in hospitals was halted. In part this was because of the inadequacy of the early flu-based strategy—a flu-strategy which mandated ending testing when there was community transmission— but partly also because of a simple lack of capacity. The abandonment of community testing meant that contact tracing—which was fundamental to the success of the Korean approach—also had to be abandoned. If people could not be tested, their contacts could not be traced.
Department for Science, Innovation and Technology
Department of Health and Social Care
Shortly after this seminal failure, in mid-March 2020 responsibility for the testing strategy was taken...
Conclusion · source text
Shortly after this seminal failure, in mid-March 2020 responsibility for the testing strategy was taken over by the Department of Health and Social Care from Public Health England.256 It was not until 18 May 2020, when the first wave of covid-19 had begun to wane in the UK, that widespread community testing for covid-19—and therefore contact tracing—was able to resume.257
Department for Science, Innovation and Technology
Department of Health and Social Care
The consequences of this initial failure were profound.
Conclusion · source text
The consequences of this initial failure were profound. Testing not only allowed individuals to be identified who had covid-19—and were infectious—but test results for an invisible virus were the only way to be able to accurately monitor the incidence and spread of the virus across the country, and to understand which groups it affected most and which it affected least.258 The UK was reduced to understanding the spread of covid-19 by waiting for people to be so sick that they needed to be admitted to hospital.
Department for Science, Innovation and Technology
Department of Health and Social Care
For a country with a world-class expertise in data analysis, to face the biggest health...
Conclusion · source text
For a country with a world-class expertise in data analysis, to face the biggest health crisis in a hundred years with virtually no data to analyse was an almost unimaginable setback. The reasons for this initial inadequacy to translate testing technology into deployable testing capacity are varied. Public Health England seemed to be better at its scientific responsibilities than in its operational response to a mass outbreak of disease and was not clearly instructed to rectify the issue.259 Public Health England reported directly to the Department of Health and Social Care, with only limited operational independence, so the Department too should have been more aware of the issue.
Department for Science, Innovation and Technology
Department of Health and Social Care
We also consider that the Government’s scientific advisers were too passive in accepting assurances that...
Conclusion · source text
We also consider that the Government’s scientific advisers were too passive in accepting assurances that the clinical operational capacity of Public Health England could not be changed. Even in March 2020, Professor Neil Ferguson explained that “much 254 Q129 255 Oral evidence taken before the Science and Technology Committee on 25 March 2020, HC (2019–21) 136, Q121 256 Oral evidence taken before the Science and Technology Committee on 21 July 2020, HC (2019–21) 136, Q1176 257 GOV.UK, ‘Everyone in the UK with symptoms now eligible for coronavirus tests’, accessed 17 September 2021 258 Oral evidence taken before the Health and Social Care Committee on 17 March 2020, HC (2019–21) 36, Q78 259 See, for example: Q825, Q1256, Q1264 and Q1280 Coronavirus: lessons learned to date 63 more widespread testing” was required but that SAGE had received “very clear messages from PHE that we would have nowhere near enough testing capacity.”260 It would have been quite possible for SAGE to advise that a significant increase in testing capacity was needed. It may be that continued adherence to the early four-stage flu plan contributed to this absence of effective scientific pressure for more testing capacity.
Department for Science, Innovation and Technology
Department of Health and Social Care
It is clear that there should have been more challenge to Public Health England to...
Conclusion · source text
It is clear that there should have been more challenge to Public Health England to increase testing capacity from the outset by Ministers, scientific advisers and the Department of Health and Social Care rather than accepting it as a fait accompli. Consequences of abandoning testing in the community
Department for Science, Innovation and Technology
Department of Health and Social Care
As noted earlier, the failure to have enough testing capacity in the early weeks of...
Conclusion · source text
As noted earlier, the failure to have enough testing capacity in the early weeks of the pandemic contributed to a lack of knowledge as to how the infection was spreading in the country. Speaking to us in November 2020, Professor Sir Chris Ham, Chair of the Coventry and Warwickshire Sustainability and Transformation Partnership, reflected that the decision to halt test and trace in the community had been a practical decision, and that any scientific advice behind it had “not been forthcoming”: if you go back to March, we simply did not have the capacity for testing, tracing and isolating that we needed in relation to the volume of cases. […] Testing capacity had to be focused on the high priorities—staff working in health and care and patients receiving that care. It was very sad that that decision had to be taken, but it was not about science. It was about practicalities.261
Department for Science, Innovation and Technology
Department of Health and Social Care
The lack of data resulting from suspending community testing also affected the UK’s understanding of...
Conclusion · source text
The lack of data resulting from suspending community testing also affected the UK’s understanding of the disease at that critical time. Professor Neil Ferguson explained to the Science and Technology Committee in June 2020 that low testing capacity meant it was difficult to estimate the proportion of imported cases which had been missed: at the time we had a policy of trying to screen people at borders, and we estimated then that maybe two thirds of imported cases had been missed. What we now know, because the epidemic took off in Italy and Spain before anybody had realised, is that probably 90% of cases imported into this country were missed by those border measures, because we were not checking people. […] Had we had the testing capacity […] screening everybody with symptoms coming in would have given us a much better impression of where infection was coming from.262 260 Oral evidence taken before the Science and Technology Committee on 25 March 2020, HC (2019–21) 136, Q20 261 Q319 and Q323 262 Oral evidence taken before the Science and Technology Committee on 10 June 2020, HC (2019–21) 136, Q870, Q873 64 Coronavirus: lessons learned to date Arguably this lack of data could have contributed to the delay in the critical decision to instigate a nationwide lockdown. As Professor Chris Whitty explained: because we had very limited testing capacity, we did not realise quite how far along the curve we were, because we were having to use people in intensive care and who had sadly died, which is quite a late event. If we had the capacity on testing then that we have now, we would have come to very different conclusions using exactly the same science.263 Professor Whitty suggested that one key lesson was to “build our capacity to do testing […] at scale”, which he described would be “a problem with any pandemic we have in the future”.264 Impact on health and social care
Department for Science, Innovation and Technology
Department of Health and Social Care
Professor Chris Whitty told the Health and Social Care Committee in July 2020 that the...
Conclusion · source text
Professor Chris Whitty told the Health and Social Care Committee in July 2020 that the lack of testing capacity available at the beginning of the pandemic meant that the Government had to focus resources very closely on the hospital sector, and in particular intensive care units.265 Within hospitals, the prioritisation of patients admitted to intensive care meant less testing capacity was available for other patients in hospital, inhibiting the safe provision of non-covid NHS care and increasing the risk of nosocomial infections. The British Infection Association, the professional association for infection specialists, stated that “decisions about who to test and when early in the pandemic almost certainly led to […] nosocomial and [healthcare worker] infections in secondary care.”266 In February, a paper submitted to SAGE by Public Health England and the London School of Hygiene and Tropical Medicine estimated that during the first wave of covid-19 alone, 36,152 people in England contracted covid-19 while in hospital, representing 40.5% of all hospital cases.267
Department for Science, Innovation and Technology
Department of Health and Social Care
The lack of available testing for social care was particularly damaging, as we discuss in...
Conclusion · source text
The lack of available testing for social care was particularly damaging, as we discuss in more detail later in this Report. Crucially, it was not until mid-April that covid-19 testing was made a requirement for people discharged from hospital to social care—even on 2 April 2020 guidance still stated that negative tests were not required for a discharge to social care.268
Department for Science, Innovation and Technology
Department of Health and Social Care
The Health and Social Care Committee’s Reports on social care and the delivery of core...
Conclusion · source text
The Health and Social Care Committee’s Reports on social care and the delivery of core NHS and care services during the pandemic also highlighted the impact of a lack of testing for social care staff in the initial wave of the pandemic. Evidence from across the sector, including from staff themselves, was unanimous that the lack of provision of regular testing for social care staff had meant that social care staff were more likely to transmit the disease within care homes.269 263 Q825 264 Q825 265 Oral evidence taken before the Health and Social Care Committee on 21 July 2020, HC (2019–21) 36, Q620 266 British Infection Association (CLL0079)) 267 Public Health England, London School of Hygiene & Tropical Medicine, The contribution of nosocomial infections to the first wave, 28 January 2021. 268 See paragraphs 263–267. 269 Health and Social Care Committee, Third Report of Session 2019–21, Social care: funding and workforce, HC 206, paras 44, 45; Health and Social Care Committee, Second Report of Session 2019–21, Delivering core NHS and care services during the pandemic and beyond, HC 320, Paras 91, 92 Coronavirus: lessons learned to date 65 100,000 tests a day target introduced by Secretary of State
Department for Science, Innovation and Technology
Department of Health and Social Care
Following the initial shortage of testing capacity and the slow increase in the availability of...
Conclusion · source text
Following the initial shortage of testing capacity and the slow increase in the availability of tests during the critical first eight weeks of the pandemic, responsibility for the testing strategy was removed from Public Health England and vested in the Department of Health and Social Care. On 2 April the then Secretary of State announced a target of carrying out 100,000 covid tests a day by the end of the month.270 This was a personal initiative on the part of the then Secretary of State, Matt Hancock MP, to jump start substantial testing capacity. At the time witnesses to the Committees distanced themselves from the 100,000 target. For example, even the then Government testing tsar, Professor John Newton, said to the Science and Technology Committee “It is not a SAGE target; it is the Secretary of State’s target […] you would have to ask the Secretary of State himself exactly where he got his advice from.”271
Department for Science, Innovation and Technology
Department of Health and Social Care
Subsequently, Dominic Cummings, in evidence to our inquiry, strongly criticised the then Secretary of State...
Conclusion · source text
Subsequently, Dominic Cummings, in evidence to our inquiry, strongly criticised the then Secretary of State for naming this target, describing it as “an incredibly stupid thing to do.”272 However, Mr Hancock defended the target, saying to the Committees, “that 100,000 target was essential in galvanising the whole system and building a diagnostics organisation and ecosystem in this country.”273 The 100,000 target was announced as having been achieved by 30 April, although to do so required including tests which had been distributed by mail but which had not been processed.
Department for Science, Innovation and Technology
Department of Health and Social Care
Given the painfully slow increase in the availability of testing before April 2020, we consider...
Conclusion · source text
Given the painfully slow increase in the availability of testing before April 2020, we consider that the impact of the Secretary of State’s target to have been an appropriate one to galvanise the rapid change the system needed. However, as such a personal and unilateral approach was needed—and appears not to have been supported by other parts of Government—it is concerning to contemplate what would have happened without this unorthodox initiative.
Department for Science, Innovation and Technology
Department of Health and Social Care
As a result of the increase in testing capacity driven during April, the UK Government...
Conclusion · source text
As a result of the increase in testing capacity driven during April, the UK Government finally resumed community testing on 18 May 2020, following an expansion of capacity, which included more than a doubling of the NHS and PHE laboratory network capacity.274 In its April 2020 testing strategy, the Department of Health and Social Care set out a “five pillar” plan for how covid-19 testing would be scaled up: • Pillar 1: Scaling up NHS swab testing for those with a medical need and, where possible, the most critical key workers; • Pillar 2: Mass-swab testing for critical key workers in the NHS, social care and other sectors; • Pillar 3: Mass-antibody testing to help determine if people have immunity to coronavirus; 270 GOV.UK, ‘Health and Social Care Secretary’s statement on coronavirus: 2 April 2020’, accessed 17 September 2021 271 Oral evidence taken before the Science and Technology Committee on 8 April 2020, HC (2019–21) 136, Q176 272 Q1062 273 Q1264 274 GOV.UK, ‘Everyone in the United Kingdom with symptoms now eligible for coronavirus tests: 18 May 2020’, accessed 17 September 2021 66 Coronavirus: lessons learned to date • Pillar 4: Surveillance testing to learn more about the disease and help develop new tests and treatments; and • Pillar 5: Spearheading a Diagnostics National Effort to build a mass-testing capacity at a completely new scale.275 The capacity for community testing was expanded further primarily under ‘Pillar 2’ of the Government’s testing strategy, through the creation of a series of Lighthouse Lab facilities from early April onwards.276 These “mega-labs” were set up through partnerships between academia, commercial partners, public bodies and not-for-profit organisations, and integrated into a “new national testing infrastructure” and served the entire United Kingdom.
Department for Science, Innovation and Technology
Department of Health and Social Care
Evidence received by the Science and Technology Committee suggested that taking a centralised approach to...
Conclusion · source text
Evidence received by the Science and Technology Committee suggested that taking a centralised approach to increasing testing capacity was appropriate as it might not have been practical to focus on boosting local-level capacity alone. For example, Dr Richard Harling, Director of Health and Care for Staffordshire County Council, suggested that the expansion of testing capacity was “unlikely to be something we would have the expertise or specialism to do locally”.277 Similarly, Greg Fell, Director of Public Health at Sheffield City Council, suggested that while Sheffield was “very early in large-scale testing […] we quickly got to a stage where we needed the large-scale labs that we now have”.278
Department for Science, Innovation and Technology
Department of Health and Social Care
However, both our Committees heard that other resources could have been used more effectively in...
Conclusion · source text
However, both our Committees heard that other resources could have been used more effectively in the initial expansion of testing capacity. Professor Sir Chris Ham explained that initially the Government was “very much focused on building capacity in the commercial Lighthouse laboratories” but suggested that this focus was to the detriment of other potential capacity: if more had been done during the summer months […] for example, we could have made greater use of university laboratories and NHS laboratories—we might have been able to add capacity to avoid the bottlenecks that occurred [in September].279 Sir Paul Nurse also made this point, referring to an earlier press release by the Francis Crick Institute, stating: We argued very early on, in March it has to be said, that we should mobilise much more locally. We turned the Crick into a testing facility. We used that terrible metaphor of Dunkirk and little ships, and so on, but we produced a testing facility locally within two weeks that was doing 2,000 tests a day.280 275 Department of Health and Social Care, Coronavirus (COVID-19)—Scaling up our testing programmes, 4 April 2020 276 GOV.UK, ‘Health Secretary launches biggest diagnostic lab network in British history to test for coronavirus: 9 April 2020’, accessed 17 September 2021 277 Oral evidence taken before the Science and Technology Committee on 27 January 2021. HC (2019–21) 136, Q1812 278 Oral evidence taken before the Science and Technology Committee on 27 January 2021. HC (2019–21) 136, Q1812 279 Q338 280 Oral evidence taken before the Health and Social Care Committee on 21 July 2020, HC (19–21) 36, Q589; Francis Crick Institute, Francis Crick Institute and UCLH develop COVID-19 testing service for patients and NHS staff, 2 April 2020 Coronavirus: lessons learned to date 67 Professor Jo Martin, President of the Royal College of Pathologists, suggested that it was not strategically wrong to set up the Lighthouse Laboratory network to process testing on a
Department for Science, Innovation and Technology
Department of Health and Social Care
Despite this, it appeared that there was a disconnect between the testing operation in the...
Conclusion · source text
Despite this, it appeared that there was a disconnect between the testing operation in the Lighthouse Laboratories and NHS labs. For example, the Institute of Biomedical Science suggested that there was a “lack of integration and collaboration” between the laboratories providing Pillar 1 testing (NHS and PHE labs) and Pillar 2 testing (e.g. Lighthouse Labs).282 Further, Professor Martin told us that there should have been “more awareness of the end- to-end process”, pointing to one example of mismatched data systems.283 “World-beating” systems and moonshots
Department for Science, Innovation and Technology
Department of Health and Social Care
Throughout the last 18 months, the test and trace system has had labels applied that...
Conclusion · source text
Throughout the last 18 months, the test and trace system has had labels applied that have been at variance with the reality. Ministers began by promising the test and trace system would be “world-beating” in May 2020 when the truth was that it was that it was a laggard.284 Antibody tests were heralded in March 2020 by Ministers as “game changers” long before their role in the system was certain.285 In September 2020, the Prime Minister announced a new “moonshot” plan with the ambition to use rapid covid-19 tests with millions of tests processed daily which would allow normal lives to be resumed without the need for social distancing.286
Department for Science, Innovation and Technology
Department of Health and Social Care
In May 2020 the label “NHS” was applied by the Department of Health and Social...
Conclusion · source text
In May 2020 the label “NHS” was applied by the Department of Health and Social Care to the test and tracing system, despite it being operated outside the NHS. It was notable that in evidence to our inquiry, the then Chief Executive of NHS England, Sir Simon Stevens, pointedly refused to use the term NHS in conjunction with the Test and Trace operation.287 Mass testing ‘moonshot’
Department for Science, Innovation and Technology
Department of Health and Social Care
The Government has pursued both mass antibody testing (to identify who previously had covid-19) and...
Conclusion · source text
The Government has pursued both mass antibody testing (to identify who previously had covid-19) and mass diagnostic testing (to identify those currently infected) as means to return to normality. In its April 2020 testing strategy, the Government said it was “committed to mass testing” and stated its “overall ambition is to provide enough swab tests for everyone that needs one”.288 On 9 September 2020, the Prime Minister announced the Government’s “moonshot” plan with the ambition to use rapid covid-19 tests “on a far bigger scale than any country has yet achieved–literally millions of tests processed every 281 Qq343–344 282 Institute of Biomedical Science (CLL0083) 283 Q344 284 HC oral questions, 20 May 2020, Vol 676 [Commons Chamber] 285 UK Prime Minister Facebook, ‘PM Boris Johnson holds the daily press conference: 18 March 2020’, accessed 17 September 2021 286 GOV.UK, ‘Prime Minister’s statement on coronavirus (COVID-19): 9 September 2020’, accessed 17 September 2021 287 Q920 288 Department of Health and Social Care, Coronavirus: Scaling up our testing programmes, 4 April 2020 68 Coronavirus: lessons learned to date single day”.289 He also stated that this plan would “allow people to lead more normal lives, without the need for social distancing”. The Prime Minister expressed hope that by Christmas 2020, venues such as theatres could benefit from mass-scale rapid testing and that the technology would be “widespread by the spring”.290
Department for Science, Innovation and Technology
Department of Health and Social Care
That optimism does not appear to have been shared by scientists advising the Government, who...
Conclusion · source text
That optimism does not appear to have been shared by scientists advising the Government, who struck a more cautious note. For example, at the same press conference Sir Patrick Vallance pointed out that the technologies still had to be trialled, saying that it was “completely wrong to assume this is a slam dunk that can definitely happen”.291 Further, a SAGE ‘task and finish group’ on mass testing concluded in late August 2020 that the use of testing as a “point-of-entry requirement” for venues and events could reduce transmission risk but it would have a “minimal effect” on reducing ‘R’.292 Following trials in different settings, most notably a citywide trial in Liverpool,293 it was not until 9 April 2021 that rapid coronavirus testing was offered to everyone in England, including those without symptoms.294
Department for Science, Innovation and Technology
Department of Health and Social Care
As with other aspects of covid-19 testing, the Government has put a significant amount of...
Conclusion · source text
As with other aspects of covid-19 testing, the Government has put a significant amount of public money towards mass testing. The NAO’s December 2020 report on test and trace indicated that (leading up to October) £2.9 billion had been earmarked for mass testing, over twice the budget allocated to tracing at that time.295 At the time of the Prime Minister’s mass testing announcement in September 2020, the British Medical Journal reported that leaked Government documents indicated that a mass testing programme might cost over £100 billion to deliver.296 However, the SAGE task and finish group warned that “careful consideration” was needed to justify whether resources allocated to mass testing would achieve a larger benefit, over “investing equivalent resources” in existing test and trace activities and improving adherence to self-isolation.297 The testing shortages of Autumn 2020
Department for Science, Innovation and Technology
Department of Health and Social Care
During the summer of 2020, rates of covid infection declined markedly in most parts of...
Conclusion · source text
During the summer of 2020, rates of covid infection declined markedly in most parts of the United Kingdom. Average hospitalisations from covid fell to 119 per day on 1 August 2020 compared to 3,000 per day in early April. Yet as soon as infections began to rise in September 2020—when schools, universities and many workplaces returned after the summer holidays—the test and trace system was found once again wanting. A period of relative calm in August did not appear to have been used to anticipate and prepare for what was likely to be needed during the Autumn. 289 GOV.UK, ‘Prime Minister’s statement on coronavirus (COVID-19): 9 September 2020’, accessed 17 September 2021 290 GOV.UK, ‘Prime Minister’s statement on coronavirus (COVID-19): 9 September 2020’, accessed 17 September 2021 291 Independent, ‘Boris Johnson’s plans for mass coronavirus testing may not work, government’s top scientific adviser warns’, 10 September 2020 292 Multidisciplinary Task and Finish Group on Mass Testing, Consensus Statement for SAGE, 31 August 2020 293 GOV.UK, ‘Liverpool to be regularly tested for coronavirus in first whole city testing pilot: 3 November 2020’, accessed 17 September 2021 294 GOV.UK, Twice weekly rapid testing to be available to everyone in England: 5 April 2021, accessed 17 September 2021 295 National Audit Office, The government’s approach to test and trace in England—interim report, 11 December 2020, page 36 296 British Medical Journal, Government plans to spend £100bn on expanding testing to 10 million a day, 9 September 2020 297 Multidisciplinary Task and Finish Group on Mass Testing, Consensus Statement for SAGE, 31 August 2020 Coronavirus: lessons learned to date 69
Department for Science, Innovation and Technology
Department of Health and Social Care
Despite undergoing a large increase in testing capacity over the first lockdown period— reaching over...
Conclusion · source text
Despite undergoing a large increase in testing capacity over the first lockdown period— reaching over 200,000 daily tests by the beginning of June 2020298—the test and trace service in England then struggled to keep up with a sharp increase in demand following the reopening of schools and universities in September 2020. To tackle that increase, NHS Test and Trace had to “limit the number of tests available, lengthen turnaround times, and commission extra assistance from NHS and ‘surge’ laboratories”.299 The Government was also forced to prioritise testing for those in the NHS and in care homes, as explained by the then Executive Chair of NHS Test and Trace, Baroness Harding.300
Department for Science, Innovation and Technology
Department of Health and Social Care
During September 2020, the Science and Technology Committee heard from Baroness Harding that NHS Test...
Conclusion · source text
During September 2020, the Science and Technology Committee heard from Baroness Harding that NHS Test and Trace had “planned for a sizeable increase” but that she “[did] not think anybody was expecting” the level of demand experienced.301 She explained one reason for the surge was that a proportion of ineligible individuals were showing up to receive covid-19 tests: we have been running some surveys […] 27% [of visitors to walk-in testing sites] said they were there because they had been in contact with someone who had tested positive, but they did not have symptoms themselves.302 This should not have been quite so unpredictable given previous advice by the then Secretary of State for Health and Social Care to get a test “if in doubt and if people think they might have the symptoms”.303 The demand for testing might also have been compounded by an issue later raised by Professor Sir John Bell that “95% of people with [perceived] symptoms do not have the disease”.304
Department for Science, Innovation and Technology
Department of Health and Social Care
The NAO’s December 2020 report pointed out further that NHS Test and Trace was unable...
Conclusion · source text
The NAO’s December 2020 report pointed out further that NHS Test and Trace was unable to meet demand due to insufficient laboratory capacity as a result of: • delays in getting new laboratories up and running; • delays in delivering testing equipment, including supply chain problems with swabs, screening kits and testing reagents; and • difficulties in staffing new laboratories.305
Department for Science, Innovation and Technology
Department of Health and Social Care
Two months earlier, in July 2020, the Government Chief Scientific Adviser, Sir Patrick Vallance, told...
Conclusion · source text
Two months earlier, in July 2020, the Government Chief Scientific Adviser, Sir Patrick Vallance, told the Science and Technology Committee that extra testing capacity would be “essential” ahead of schools reopening.306 However, he suggested that the Government did 298 GOV.UK, UK reaches 200,000 coronavirus testing capacity target a day early: 31 May 2020, accessed 17 September 2021 299 National Audit Office, The government’s approach to test and trace in England—interim report, 11 December 2020, page 10 300 Oral evidence taken before the Science and Technology Committee on 17 September 2020, HC (2019–21) 136, Qq1327–1329 301 Oral evidence taken before the Science and Technology Committee on 17 September 2020, HC (2019–21) 136, Qq1314–1326 302 Oral evidence taken before the Science and Technology Committee on 17 September 2020, HC (2019–21) 136, Q1306 303 HC Deb, 20 July 2020, col 1855 [Commons Chamber] 304 Q346 305 National Audit Office, The government’s approach to test and trace in England—interim report, 11 December 2020, page 50 306 Oral evidence taken before the Science and Technology Committee on 16 July 2020, HC (2019–21) 136, Qq1149– 1154 70 Coronavirus: lessons learned to date not have the capacity to meet the potential demand of over 350,000 tests per day, a figure suggested by the Academy of Medical Sciences at the time.307 Nevertheless, Baroness Harding suggested that the level of demand encountered in September was “in none of the modelling” used by NHS Test and Trace to assess capacity.308 She told the Science and Technology Committee that capacity plans had been “based on SAGE modelling for what we should be preparing for in the autumn”, and that it was SAGE’s assessment rather than NHS Test and Trace’s.309 However, she later wrote to the Committee in a follow-up letter to clarify that SAGE had not informed the capacity targets: SAGE has not been responsible for providing modelling analysis on operational testing capacity […] In order to model and for
Department for Science, Innovation and Technology
Department of Health and Social Care
Overall, the National Audit Office concluded that NHS Test and Trace “did not plan for...
Conclusion · source text
Overall, the National Audit Office concluded that NHS Test and Trace “did not plan for a sharp rise in testing demand in early Autumn [2020]” and was therefore “unprepared.”311 Professor Chris Whitty reiterated to both Committees in December 2020 that one key learning was the need to scale up testing capacity, stating that the UK had been “caught out twice now with lack of testing, and three times would be too many”.312 By January 2021 testing capacity had reportedly increased to 800,000 per day and Baroness Harding expressed that she was “very confident” that there was sufficient capacity to handle future potential surges—citing the increased demand over Christmas as an example.313
Department for Science, Innovation and Technology
Department of Health and Social Care
The failure of the test and trace system to rise to meet even the most...
Recommendation · source text
The failure of the test and trace system to rise to meet even the most predictable of demands in Autumn 2020, especially given many weeks to prepare, suggests that lessons that were learnable during the pandemic were not applied. An urgent priority for the Government must be to satisfy itself that there is now a dependable organisation for covid testing that can both anticipate and meet future demands. The role of Test and Trace in autumn lockdowns
Department for Science, Innovation and Technology
Department of Health and Social Care
The UK has established procedures and structures to prepare for the nation’s major future risks,...
Conclusion · source text
The UK has established procedures and structures to prepare for the nation’s major future risks, including a National Risk Register, the Civil Contingencies Secretariat and the Scientific Advisory Group for Emergencies (SAGE). However, the anticipated future risk of pandemic disease focused too closely on influenza rather than diseases like SARS and MERS that had in recent years appeared in Asian countries.
Department for Science, Innovation and Technology
Department of Health and Social Care
Previous exercises to test the national response capability, namely Exercises Cygnus and Winter Willow, did...
Conclusion · source text
Previous exercises to test the national response capability, namely Exercises Cygnus and Winter Willow, did not squarely address a disease with the characteristics of covid-19. Nevertheless, some useful lessons were learned and applied, such as the drafting of legislative measures that might be needed.
Department for Science, Innovation and Technology
Department of Health and Social Care
The operation of COBR was not well-suited to the modern demands of a pandemic response.
Conclusion · source text
The operation of COBR was not well-suited to the modern demands of a pandemic response. It is especially concerning that its culture of confidentiality was considered by some to be so unreliable that alternative meetings were arranged that could command greater confidentiality among participants.
Department for Science, Innovation and Technology
Department of Health and Social Care
The Civil Contingencies Secretariat did not have adequate resources to maintain a substantial standing capability...
Conclusion · source text
The Civil Contingencies Secretariat did not have adequate resources to maintain a substantial standing capability to survey the development of potential threats, and it had a limited reach into the range of Government departments required to respond to a pandemic. The experience has been that this investment in resilience is at risk of being trumped by the day-to-day pressures of Government.
Department for Science, Innovation and Technology
Department of Health and Social Care
Protocols to share data between public bodies involved in the response were too slow to...
Conclusion · source text
Protocols to share data between public bodies involved in the response were too slow to establish and to become functional. This was especially true in the data flows from national to local government.
Department for Science, Innovation and Technology
Department of Health and Social Care
The NHS responded quickly and strongly to the demands of the pandemic, but compared to...
Conclusion · source text
The NHS responded quickly and strongly to the demands of the pandemic, but compared to other health systems it “runs hot”—with little spare capacity built in to cope with sudden and unexpected surges of demand such as in a pandemic.
Department for Science, Innovation and Technology
Department of Health and Social Care
A greater diversity of expertise and challenge—including from practitioners from other countries and a wider...
Recommendation · source text
A greater diversity of expertise and challenge—including from practitioners from other countries and a wider range of disciplines—should be included in the framing of the National Risk Register and the plans that emanate from it. Plans for the future should include a substantial and systematic method of learning from international practice during the course of an emergency.
Department for Science, Innovation and Technology
Department of Health and Social Care
A standing capability should be established in Government, or reporting to it, to scan the...
Recommendation · source text
A standing capability should be established in Government, or reporting to it, to scan the horizon for future threats, with adequate resource and counting on specialists with an independence from short-term political and administrative pressures. (Paragraph 65) Coronavirus: lessons learned to date 125
Department for Science, Innovation and Technology
Department of Health and Social Care
The Government should ensure comprehensive plans are made for future risks and emergencies.
Recommendation · source text
The Government should ensure comprehensive plans are made for future risks and emergencies. The UK should aim to be a world leader in co-ordinating international resilience planning, including reform of the World Health Organisation to ensure that it is able to play a more effective role in future pandemics.
Department for Science, Innovation and Technology
Department of Health and Social Care
The resourcing and capabilities of the Civil Contingencies Secretariat should be improved.
Recommendation · source text
The resourcing and capabilities of the Civil Contingencies Secretariat should be improved. The Civil Contingencies Secretariat should be empowered to ‘stress test’ plans and to ensure that Departments are able to carry out a contingency plan if required. The details and results of these stress tests should be included in the Cabinet Office’s annual report.
Department for Science, Innovation and Technology
Department of Health and Social Care
Arrangements should be established and tested to allow immediate flows of data between bodies relevant...
Recommendation · source text
Arrangements should be established and tested to allow immediate flows of data between bodies relevant to an emergency response with a mechanism to resolve immediately and decisively any disputes.
Department for Science, Innovation and Technology
Department of Health and Social Care
The Armed Forces should have a more central and standing role in preparing for and...
Recommendation · source text
The Armed Forces should have a more central and standing role in preparing for and responding to emergencies like pandemics, given the depth of capability and experience they have in planning, logistics and rapid mobilisation. The Civil Contingencies Secretariat should work with the Armed Forces to improve operational expertise in emergencies in public bodies.
Department for Science, Innovation and Technology
Department of Health and Social Care
The Government and the NHS should consider establishing a volunteer reserve database so that volunteers...
Recommendation · source text
The Government and the NHS should consider establishing a volunteer reserve database so that volunteers who have had appropriate checks can be rapidly called up and deployed in an emergency rather than needing to begin from scratch.
Department for Science, Innovation and Technology
Department of Health and Social Care
The experience of the demands placed on the NHS during the covid-19 pandemic should lead...
Conclusion · source text
The experience of the demands placed on the NHS during the covid-19 pandemic should lead to a more explicit, and monitored, surge capacity being part of the long term organisation and funding of the NHS.
Department for Science, Innovation and Technology
Department of Health and Social Care
The NHS should develop and publish new protocols for infection prevention and control in pandemics...
Recommendation · source text
The NHS should develop and publish new protocols for infection prevention and control in pandemics covering staffing, bed capacity and physical infrastructure. In developing these protocols the NHS should consider the importance of maintaining access for people accompanying some patients such as advocates for people with learning disabilities and birthing partners.
Department for Science, Innovation and Technology
Department of Health and Social Care
Comprehensive analysis should be carried out to assess the safety of running the NHS with...
Recommendation · source text
Comprehensive analysis should be carried out to assess the safety of running the NHS with the limited latent capacity that it currently has, particularly in Intensive Care Units, critical care units and high dependency units.
Department for Science, Innovation and Technology
Department of Health and Social Care
Building on the experience of staff working more flexibly during the pandemic and to enable...
Recommendation · source text
Building on the experience of staff working more flexibly during the pandemic and to enable more flexible staffing in the NHS, NHS England and Health Education England should develop proposals to better enable NHS staff to change clinical specialty mid- career and train in sub-specialties. (Paragraph 74) Lockdowns and social distancing
Department for Science, Innovation and Technology
Department of Health and Social Care
During the first three months of the covid pandemic, the UK followed the wrong policy...
Conclusion · source text
During the first three months of the covid pandemic, the UK followed the wrong policy in its use of non-pharmaceutical interventions. When the UK moved from the ‘contain’ to ‘delay’ stage, there was a policy of seeking to only moderate the speed of infection through the population—flattening the curve—rather than seeking to arrest its spread. The policy was pursued until 23 March because of the official 126 Coronavirus: lessons learned to date scientific advice the Government received, not in spite of it. Questions remain about whether the containment phase was pursued aggressively enough—we believe it could have been pursued for longer. During this period Government policy did not deviate from the scientific advice it received in any material respect. The fact that the UK approach reflected a consensus between official scientific advisers and the Government indicates a degree of groupthink that was present at the time which meant we were not as open to approaches being taken elsewhere—such as earlier lockdowns, border controls and effective test and trace—as we should have been.
Department for Science, Innovation and Technology
Department of Health and Social Care
The flattening the curve policy was implemented by introducing new restrictions only gradually and slowly,...
Conclusion · source text
The flattening the curve policy was implemented by introducing new restrictions only gradually and slowly, acting as if the spread of the virus were susceptible to calibrated control. Modelling at the time suggested that to suppress the spread of covid-19 too firmly would cause a resurgence when restrictions were lifted. This was thought likely to result in a peak in the autumn and winter when NHS pressures were already likely to be severe. In addition, it was thought that the public would only comply with severe restrictions for a limited period, and so those restrictions should not be applied before they were most needed. This approach should have been questioned at the time for a number of reasons: • it entailed people contracting covid in large numbers with hundreds of thousands of deaths likely to result; • other countries, in Asia and in Europe, including some with experience of SARS and MERS, had chosen to implement earlier, more comprehensive strategies of non-pharmaceutical interventions, which were having success; and • suppressing the spread of the virus in the early period would have bought valuable time to consider what was the best way to manage the pandemic in the medium term.
Department for Science, Innovation and Technology
Department of Health and Social Care
There are several possible explanations for what was a significant error in policy and advice...
Conclusion · source text
There are several possible explanations for what was a significant error in policy and advice early in the pandemic. These include: • the lack of adequate data on the spread of covid-19, as a result of the inadequacy of the UK testing operation; • overreliance on specific mathematical models when there were too many uncertainties; • assumptions about public compliance with rules that turned out to have underestimated the willingness to conform even for long periods; • the composition of SAGE suffered from a lack of representation from outside the United Kingdom; and • a preference for a particular UK approach may have been favoured above advice based on emulation of what was being pursued elsewhere. (Paragraph 154) Coronavirus: lessons learned to date 127
Department for Science, Innovation and Technology
Department of Health and Social Care
Science proceeds through challenge and disputation, and new theories are tested unflinchingly against evidence.
Conclusion · source text
Science proceeds through challenge and disputation, and new theories are tested unflinchingly against evidence. Yet Ministers and other advisers reported that they felt it difficult to challenge the views of their official scientific advisers. Those in Government have a duty to question and probe the assumptions behind any scientific advice given, particularly in a national emergency, but there is little evidence sufficient challenge took place. However, even when UK policy had changed to bring in a comprehensive national lockdown, the role of non-pharmaceutical interventions against covid-19 was complex, inconsistent and opaque for most of the rest of 2020.
Department for Science, Innovation and Technology
Department of Health and Social Care
The second wave of covid infections, hospitalisations and deaths during the autumn and winter of...
Conclusion · source text
The second wave of covid infections, hospitalisations and deaths during the autumn and winter of 2020/21 was significantly driven by the emergence of a new variant, known as the Kent or Alpha variant. It is likely that a “circuit break” of temporary lockdown measures if introduced in September 2020, and earlier lockdown measures during the winter, could have impeded the rapid seeding and spread of the Kent variant. However, the existence of the Kent or Alpha variant was not known by the Government until 11 December 2020 so that the justification for taking earlier measures could not rely on information available at the time.
Department for Science, Innovation and Technology
Department of Health and Social Care
Government public health communications are key to the public’s understanding of and compliance with non-pharmaceutical...
Conclusion · source text
Government public health communications are key to the public’s understanding of and compliance with non-pharmaceutical interventions. Initial messaging from the Government early in the pandemic was strong, effective and undoubtedly contributed to the success of the first lockdown. After the gradual lifting of the first lockdown from May 2020, Government guidance became increasingly complex and harder to understand, with restrictions varying in different parts of the country. Government communications did not always reflect this nuance, leading to perceived inconsistency and divergent strategies across the four nations of the UK.
Department for Science, Innovation and Technology
Department of Health and Social Care
In the early days of a crisis, scientific advice may be necessarily uncertain: data may...
Conclusion · source text
In the early days of a crisis, scientific advice may be necessarily uncertain: data may be unavailable, knowledge limited and time may be required for analysis to be conducted. In these circumstances it may be appropriate to act quickly, on a precautionary basis, rather than wait for more scientific certainty.
Department for Science, Innovation and Technology
Department of Health and Social Care
In future an approach of greater questioning and challenge should characterise the development of policy.
Recommendation · source text
In future an approach of greater questioning and challenge should characterise the development of policy. Ministers should have the confidence to follow a scientific approach themselves—being prepared to take a more robust approach to questioning and challenging the advice given. The Government and SAGE should also facilitate strong external and structured challenge to scientific advice, including from experts in countries around the world, and a wider range of disciplines.
Department for Science, Innovation and Technology
Department of Health and Social Care
In bringing together many of the UK’s most accomplished scientists, SAGE became a very UK...
Recommendation · source text
In bringing together many of the UK’s most accomplished scientists, SAGE became a very UK body. In future, it should include more representation and a wider range of disciplines, from other countries, especially those which have experienced, or are experiencing, the same emergency. (Paragraph 160) 128 Coronavirus: lessons learned to date
Department for Science, Innovation and Technology
Department of Health and Social Care
In a pandemic, the scientific advice from the SAGE co-chairs to the Government should be...
Recommendation · source text
In a pandemic, the scientific advice from the SAGE co-chairs to the Government should be published within 24 hours of it being given, or the policy being decided, whichever is the later, to ensure the opportunity for rapid scientific challenge and guard against the risk of ‘groupthink’. In addition, minutes and SAGE papers should be published within 48 hours of the meeting taking place.
Department for Science, Innovation and Technology
Department of Health and Social Care
The Government, via the World Health Organisation, should make the case for an international standard...
Recommendation · source text
The Government, via the World Health Organisation, should make the case for an international standard of reporting covid-19 deaths and a framework for reporting disease related deaths for future pandemics. (Paragraph 162) Testing and contact tracing
Department for Science, Innovation and Technology
Department of Health and Social Care
Despite being one of the first countries in the world to develop a test for...
Conclusion · source text
Despite being one of the first countries in the world to develop a test for covid in January 2020, the United Kingdom failed to translate that scientific leadership into operational success in establishing an effective test and trace system during the first year of the pandemic. Public Health England showed itself to be scientifically accomplished, but poor at delivering an operational testing system at the scale and urgency required by a pandemic.
Department for Science, Innovation and Technology
Department of Health and Social Care
Testing capacity was treated too much as a parameter rather than a variable that could...
Conclusion · source text
Testing capacity was treated too much as a parameter rather than a variable that could be changed by the Department of Health and Social Care and scientific advisers. What was being achieved in other countries, particularly East Asia, appeared to be of little interest in the initial weeks of the pandemic. This was an inexcusable oversight. It took a personal intervention by the then Secretary of State in April 2020 to drive a major increase in testing capacity.
Department for Science, Innovation and Technology
Department of Health and Social Care
The resulting requirement to abandon testing people in the community during the critical early period...
Conclusion · source text
The resulting requirement to abandon testing people in the community during the critical early period of the pandemic cost many lives for a number of reasons including because: a) many asymptomatic carriers were not tested and therefore identified and asked to isolate; b) many older people were admitted to care homes either from the community or hospitals in ignorance of their covid status or that of staff working in care homes; c) low levels of testing meant that the UK lost visibility of where the disease was spreading, among which groups and how quickly. For a crucial period our only insight into the spread of covid was by counting people so sick that they had to be admitted to hospital; and (Paragraph 234.c)) d) the receipt of a positive test result would have been likely to improve compliance with an isolation request.
Department for Science, Innovation and Technology
Department of Health and Social Care
The new Test and Trace operation eventually established in May 2020 was a step in...
Conclusion · source text
The new Test and Trace operation eventually established in May 2020 was a step in the right direction but set up much too late. Because of that delay there was huge pressure to get results quickly which meant that it followed a centralised model initially, meaning assistance from laboratories outside PHE—particularly university laboratories—was rebuffed. The same was true for contact tracing, where the established capabilities of local Directors of Public Health and their teams were Coronavirus: lessons learned to date 129 not effectively harnessed during the initial response to the pandemic, despite local approaches providing effective in places where they were pursued. It is now clear that the optimal structure for test and trace is one that is locally driven with the ability to draw on central surge capacity—but it took the best part of a year to get to that point. In short, implementation was too centralised when it ought to have been more decentralised.
Department for Science, Innovation and Technology
Department of Health and Social Care
Vast sums of taxpayers’ money were directed to Test and Trace, justified by the benefits...
Conclusion · source text
Vast sums of taxpayers’ money were directed to Test and Trace, justified by the benefits of avoiding further lockdowns. But ultimately those lockdowns happened. Were it not for the success of the Vaccine Taskforce and the NHS vaccination programme, it is likely that further lockdown restrictions would have been needed in Summer 2021.
Department for Science, Innovation and Technology
Department of Health and Social Care
We recognise that the effectiveness of test and trace in reducing transmission is likely to...
Conclusion · source text
We recognise that the effectiveness of test and trace in reducing transmission is likely to be reduced when the prevalence of the virus is high, as highlighted by Professor Whitty and others, but it is clear from the latest data and the experience of September 2020 that even at the level of operational effectiveness, NHS Test and Trace has been unable to respond to rising rates of transmission of covid-19.
Department for Science, Innovation and Technology
Department of Health and Social Care
The Test and Trace organisation has not, despite its branding, been run by the NHS,...
Conclusion · source text
The Test and Trace organisation has not, despite its branding, been run by the NHS, and has seen senior executives brought in from external bodies for short term contracts which reduces the institutional learning, from what was an intense period, that has been retained. It is a major concern that the new organisation responsible for test and trace is opaque in its structure and organisation.
Department for Science, Innovation and Technology
Department of Health and Social Care
Partly because it was set up too late, NHS Test and Trace ultimately fell short...
Conclusion · source text
Partly because it was set up too late, NHS Test and Trace ultimately fell short of the expectations set for it. It has failed to make a significant enough impact on the course of the pandemic to justify the level of public investment it received. It clearly failed on its own terms, given its aim in September to “avoid the need for a second lockdown” by contributing to a reduction in the ‘R’ number. While we acknowledge that test, trace and isolate activities are just one—albeit crucial—component of the measures undertaken to tackle covid-19, NHS Test and Trace (NHSTT) clearly failed to achieve this central objective. NHSTT has also consistently failed to reach the 72- hour turnaround time as identified as necessary by SAGE, including a significant failure in September 2020. Further, although the Government first described the impact of NHSTT on reducing ‘R’ in December, it took an unacceptably long two months before the evidence and analysis behind this assertion was made public. When it was published it became clear that the analysis was outdated, invalidating claims made at the time. The use of inaccurate data and the lack of transparency impeded effective public scrutiny at a crucial time in the pandemic.
Department for Science, Innovation and Technology
Department of Health and Social Care
The National Audit Office has stated that “to achieve value for money NHST&T must be...
Conclusion · source text
The National Audit Office has stated that “to achieve value for money NHST&T must be able to demonstrate both that the interventions it delivers are effective in achieving its objective, and that the mix of interventions is the most cost-effective use of public resources.” After 18 months and many billions of pounds of taxpayers’ funds, there is hope that the UK now has a capacity for testing and tracing that is adequate. It is a bitter irony that this point may only have been reached at the point in which the vaccination programme makes testing less of a critical component than it was previously. (Paragraph 240) 130 Coronavirus: lessons learned to date
Department for Science, Innovation and Technology
Department of Health and Social Care
Scientific excellence is not enough in test and trace programmes: the UK must develop greater...
Recommendation · source text
Scientific excellence is not enough in test and trace programmes: the UK must develop greater operational competence in deployment. In particular, the Government must ensure that both the new UK Health Security Agency and local authorities have the capability and funding to stand up both central surge capacity and locally-driven testing and contact tracing within seven days of a public health emergency being declared.
Department for Science, Innovation and Technology
Department of Health and Social Care
Public Health England and its successor bodies, as well as Ministers and their scientific advisers,...
Recommendation · source text
Public Health England and its successor bodies, as well as Ministers and their scientific advisers, should be more willing to study and emulate the practice of other countries with urgency and agility, especially during a crisis. A culture must be established that looks proactively to collaborate with other organisations, rather than to reject assistance.
Department for Science, Innovation and Technology
Department of Health and Social Care
Those responsible for future test and trace programmes should establish a culture and processes to...
Recommendation · source text
Those responsible for future test and trace programmes should establish a culture and processes to learn rapidly from errors and to act to prevent them being repeated.
Department for Science, Innovation and Technology
Department of Health and Social Care
The reactive, short-term horizon of test and trace for much of the pandemic must be...
Recommendation · source text
The reactive, short-term horizon of test and trace for much of the pandemic must be replaced by a capacity for anticipation and preparation—even during the course of an emergency.
Department for Science, Innovation and Technology
Department of Health and Social Care
The organisation of the bodies responsible for testing and tracing should be open and transparent...
Recommendation · source text
The organisation of the bodies responsible for testing and tracing should be open and transparent both about their operations and the basis of their decisions. (Paragraph 245) Social care
Department for Science, Innovation and Technology
Department of Health and Social Care
The covid-19 pandemic has put massive strain on a social care sector already under huge...
Conclusion · source text
The covid-19 pandemic has put massive strain on a social care sector already under huge pressure, which has a particular focus on caring for elderly people who have been at the greatest risk of death from covid.
Department for Science, Innovation and Technology
Department of Health and Social Care
Social care had a less prominent voice in Government during the early stages of the...
Conclusion · source text
Social care had a less prominent voice in Government during the early stages of the pandemic than did the NHS.
Department for Science, Innovation and Technology
Department of Health and Social Care
The discharge of elderly people from NHS hospitals into care homes without having been tested...
Conclusion · source text
The discharge of elderly people from NHS hospitals into care homes without having been tested at the beginning of the pandemic—while understandable as the NHS prepared to accept a surge of covid patients—had the unintended consequence of contributing to the spread of infection in care homes. The seeding of infections also happened as a result of staff entering care homes, and the failure to recognise this risk early is a symptom of the inadequate initial focus on social care. The lack of available testing at the time meant that the extent of spread by each route of transmission cannot be fully known and has not been conclusively determined by the report commissioned from PHE by the Government.
Department for Science, Innovation and Technology
Department of Health and Social Care
Staff shortages, the lack of testing, difficulties in obtaining PPE and the design of care...
Conclusion · source text
Staff shortages, the lack of testing, difficulties in obtaining PPE and the design of care settings to enable communal living hampered isolation and infection control and the ability to keep covid at bay. Social care staff in care homes and providing domiciliary care worked under strenuous conditions, at risk to themselves, to provide care to people. (Paragraph 291) Coronavirus: lessons learned to date 131
Department for Science, Innovation and Technology
Department of Health and Social Care
Many of these pressures on the social care sector—such as funding and workforce— are longstanding...
Recommendation · source text
Many of these pressures on the social care sector—such as funding and workforce— are longstanding and must be resolved urgently. Pressures on the social care workforce are likely to be compounded this autumn by the mandate that people working in the social care sector must be fully vaccinated to continue to provide care in residential care homes.
Department for Science, Innovation and Technology
Department of Health and Social Care
Planning for future pandemics should have a more developed and explicit consideration of the intense...
Recommendation · source text
Planning for future pandemics should have a more developed and explicit consideration of the intense interaction between the NHS and social care. The prominence of social care within the Department of Health and Social Care should be enhanced and Ministers must address the relative lack of knowledge and experience of social care within the Department and senior levels of the NHS. The Department should ensure that future policy and guidance relating to the sector is well-informed and reflects the diversity of the sector. The Department must also set out how it plans to retain the expertise of the Social Care Taskforce on a more permanent basis.
Department for Science, Innovation and Technology
Department of Health and Social Care
Long term reform of social care is overdue and should be pursued as a matter...
Recommendation · source text
Long term reform of social care is overdue and should be pursued as a matter of urgency. The Government’s recent announcement on the future of social care is welcome, but the long-term future of the sector remains unresolved. We endorse the Health and Social Care Committee’s call for a 10 Year Plan for Social Care to accompany the 10 Year Plan for the NHS. It must ensure that there is parity between the health and care sectors so that social care is given proper priority in a future crisis.
Department for Science, Innovation and Technology
Department of Health and Social Care
We endorse the Health and Social Care Committee’s call for additional resources to be directed...
Recommendation · source text
We endorse the Health and Social Care Committee’s call for additional resources to be directed to social care. That Committee has made the case for an increase of £7 billion a year by 2023/4. We note that despite the Government’s recent announcement the level of new investment in social care from 2023/24 remains unclear.
Department for Science, Innovation and Technology
Department of Health and Social Care
The Government should review the provision of infection prevention and control measures, including infection prevention...
Recommendation · source text
The Government should review the provision of infection prevention and control measures, including infection prevention and control nurses, to social care and ensure that social care providers, particularly care homes, are able to conduct regular pandemic preparedness drills. The Government must ensure that care homes have isolation facilities and social care providers are able to provide safe visiting for family and friends of care home residents. (Paragraph 296) At risk communities
Department for Science, Innovation and Technology
Department of Health and Social Care
The impact of covid-19 has been uneven across the population, with some sections of society...
Conclusion · source text
The impact of covid-19 has been uneven across the population, with some sections of society suffering significantly higher illness and deaths than the nation as a whole.
Department for Science, Innovation and Technology
Department of Health and Social Care
During the initial phase of the pandemic Black, Asian and minority ethnic people experienced significantly...
Conclusion · source text
During the initial phase of the pandemic Black, Asian and minority ethnic people experienced significantly higher levels of severe illness and death from covid than was typical the population as a whole. Research conducted so far suggests that the drivers of these elevated levels of impact among Black, Asian and minority ethnic people arise from greater likelihood of jobs that come with higher exposure to covid infection; more challenging social and economic circumstances; more densely occupied housing; and comorbidities from different health conditions. These are classic features of inequality in society and in the economy. (Paragraph 331) 132 Coronavirus: lessons learned to date
Department for Science, Innovation and Technology
Department of Health and Social Care
Staff from Black, Asian and minority ethnic backgrounds are crucial to the NHS and care...
Conclusion · source text
Staff from Black, Asian and minority ethnic backgrounds are crucial to the NHS and care sectors. The covid-19 pandemic has brought the experiences of these staff into sharp focus. It is telling that the first ten NHS staff to die from covid-19 were from Black, Asian and minority ethnic backgrounds, and evidence has since confirmed that the impact of covid-19 on this section of the workforce has been significant. While the NHS has made progress in recent years, the experience of people from BAME groups during the pandemic has made it clear that inequalities persist.
Department for Science, Innovation and Technology
Department of Health and Social Care
People with learning disabilities have experienced significantly higher death rates from covid-19 than the country...
Conclusion · source text
People with learning disabilities have experienced significantly higher death rates from covid-19 than the country as a whole. Deaths have been especially high among younger adults with learning disabilities. Initial research suggests that people with learning disabilities entered the pandemic from a position of heightened vulnerability because of existing comorbidities. This was compounded by particular barriers to accessing NHS treatment during the pandemic arising from restrictions on non- covid care and limits on the ability of carers and advocates to attend hospital with people with learning disabilities.
Department for Science, Innovation and Technology
Department of Health and Social Care
Although there was never national NHS guidance to apply “Do not attempt CPR” (DNACPR) notices...
Conclusion · source text
Although there was never national NHS guidance to apply “Do not attempt CPR” (DNACPR) notices to people with learning disabilities, there have been widespread concerns that there were cases in which they have been issued inappropriately during the pandemic.
Department for Science, Innovation and Technology
Department of Health and Social Care
The Government should ensure its ‘levelling up’ agenda includes specific policies to reduce health inequalities,...
Recommendation · source text
The Government should ensure its ‘levelling up’ agenda includes specific policies to reduce health inequalities, with a particular focus on ensuring that certain groups, including people from Black, Asian and minority ethnic backgrounds, do not continue to face unequal health outcomes.
Department for Science, Innovation and Technology
Department of Health and Social Care
The UK has established procedures and structures to prepare for the nation’s major future risks,...
Conclusion · source text
The UK has established procedures and structures to prepare for the nation’s major future risks, including a National Risk Register, the Civil Contingencies Secretariat and the Scientific Advisory Group for Emergencies (SAGE). However, the anticipated future risk of pandemic disease focused too closely on influenza rather than diseases like SARS and MERS that had in recent years appeared in Asian countries.
Department for Science, Innovation and Technology
Department of Health and Social Care
Previous exercises to test the national response capability, namely Exercises Cygnus and Winter Willow, did...
Conclusion · source text
Previous exercises to test the national response capability, namely Exercises Cygnus and Winter Willow, did not squarely address a disease with the characteristics of covid-19. Nevertheless, some useful lessons were learned and applied, such as the drafting of legislative measures that might be needed. 93 Healthcare Infection Society (CLL0071) 94 Q872; Paragraphs 318–19 95 Healthcare Infection Society (CLL0071) 96 Q941 30 Coronavirus: lessons learned to date
Department for Science, Innovation and Technology
Department of Health and Social Care
The operation of COBR was not well-suited to the modern demands of a pandemic response.
Conclusion · source text
The operation of COBR was not well-suited to the modern demands of a pandemic response. It is especially concerning that its culture of confidentiality was considered by some to be so unreliable that alternative meetings were arranged that could command greater confidentiality among participants.
Department for Science, Innovation and Technology
Department of Health and Social Care
The Civil Contingencies Secretariat did not have adequate resources to maintain a substantial standing capability...
Conclusion · source text
The Civil Contingencies Secretariat did not have adequate resources to maintain a substantial standing capability to survey the development of potential threats, and it had a limited reach into the range of Government departments required to respond to a pandemic. The experience has been that this investment in resilience is at risk of being trumped by the day-to-day pressures of Government.
Department for Science, Innovation and Technology
Department of Health and Social Care
Protocols to share data between public bodies involved in the response were too slow to...
Conclusion · source text
Protocols to share data between public bodies involved in the response were too slow to establish and to become functional. This was especially true in the data flows from national to local government.
Department for Science, Innovation and Technology
Department of Health and Social Care
The NHS responded quickly and strongly to the demands of the pandemic, but compared to...
Conclusion · source text
The NHS responded quickly and strongly to the demands of the pandemic, but compared to other health systems it “runs hot”—with little spare capacity built in to cope with sudden and unexpected surges of demand such as in a pandemic. Recommendations and lessons learned
Department for Science, Innovation and Technology
Department of Health and Social Care
A greater diversity of expertise and challenge—including from practitioners from other countries and a wider...
Recommendation · source text
A greater diversity of expertise and challenge—including from practitioners from other countries and a wider range of disciplines—should be included in the framing of the National Risk Register and the plans that emanate from it. Plans for the future should include a substantial and systematic method of learning from international practice during the course of an emergency.
Department for Science, Innovation and Technology
Department of Health and Social Care
A standing capability should be established in Government, or reporting to it, to scan the...
Recommendation · source text
A standing capability should be established in Government, or reporting to it, to scan the horizon for future threats, with adequate resource and counting on specialists with an independence from short-term political and administrative pressures.
Department for Science, Innovation and Technology
Department of Health and Social Care
The Government should ensure comprehensive plans are made for future risks and emergencies.
Recommendation · source text
The Government should ensure comprehensive plans are made for future risks and emergencies. The UK should aim to be a world leader in co-ordinating international resilience planning, including reform of the World Health Organisation to ensure that it is able to play a more effective role in future pandemics.
Department for Science, Innovation and Technology
Department of Health and Social Care
The resourcing and capabilities of the Civil Contingencies Secretariat should be improved.
Recommendation · source text
The resourcing and capabilities of the Civil Contingencies Secretariat should be improved. The Civil Contingencies Secretariat should be empowered to ‘stress test’ plans and to ensure that Departments are able to carry out a contingency plan if required. The details and results of these stress tests should be included in the Cabinet Office’s annual report.
Department for Science, Innovation and Technology
Department of Health and Social Care
Arrangements should be established and tested to allow immediate flows of data between bodies relevant...
Recommendation · source text
Arrangements should be established and tested to allow immediate flows of data between bodies relevant to an emergency response with a mechanism to resolve immediately and decisively any disputes.
Department for Science, Innovation and Technology
Department of Health and Social Care
The Armed Forces should have a more central and standing role in preparing for and...
Recommendation · source text
The Armed Forces should have a more central and standing role in preparing for and responding to emergencies like pandemics, given the depth of capability and experience they have in planning, logistics and rapid mobilisation. The Civil Contingencies Secretariat should work with the Armed Forces to improve operational expertise in emergencies in public bodies. Coronavirus: lessons learned to date 31
Department for Science, Innovation and Technology
Department of Health and Social Care
The Government and the NHS should consider establishing a volunteer reserve database so that volunteers...
Recommendation · source text
The Government and the NHS should consider establishing a volunteer reserve database so that volunteers who have had appropriate checks can be rapidly called up and deployed in an emergency rather than needing to begin from scratch.
Department for Science, Innovation and Technology
Department of Health and Social Care
The experience of the demands placed on the NHS during the covid-19 pandemic should lead...
Recommendation · source text
The experience of the demands placed on the NHS during the covid-19 pandemic should lead to a more explicit, and monitored, surge capacity being part of the long term organisation and funding of the NHS.
Department for Science, Innovation and Technology
Department of Health and Social Care
The NHS should develop and publish new protocols for infection prevention and control in pandemics...
Recommendation · source text
The NHS should develop and publish new protocols for infection prevention and control in pandemics covering staffing, bed capacity and physical infrastructure. In developing these protocols the NHS should consider the importance of maintaining access for people accompanying some patients such as advocates for people with learning disabilities and birthing partners.
Department for Science, Innovation and Technology
Department of Health and Social Care
Comprehensive analysis should be carried out to assess the safety of running the NHS with...
Recommendation · source text
Comprehensive analysis should be carried out to assess the safety of running the NHS with the limited latent capacity that it currently has, particularly in Intensive Care Units, critical care units and high dependency units.
Department for Science, Innovation and Technology
Department of Health and Social Care
Building on the experience of staff working more flexibly during the pandemic and to enable...
Recommendation · source text
Building on the experience of staff working more flexibly during the pandemic and to enable more flexible staffing in the NHS, NHS England and Health Education England should develop proposals to better enable NHS staff to change clinical specialty mid-career and train in sub-specialties. 32 Coronavirus: lessons learned to date 3 Lockdowns and social distancing
Department for Science, Innovation and Technology
Department of Health and Social Care
Much of the impact of covid-19 during the first wave was determined by decisions made...
Conclusion · source text
Much of the impact of covid-19 during the first wave was determined by decisions made during the early weeks of the pandemic, between January and late March 2020. The seriousness of the threat to the UK was recognised in January when the Government’s Scientific Advisory Group for Emergencies—SAGE—was convened and met on 22 January 2020.97 It is important to record that all decisions taken during those initial weeks were taken in a fog of uncertainty. The UK did not know to what extent covid-19 had entered the country, how many people it was affecting, how quickly it would spread, and what would be the consequences in terms of illness and death. What the UK did know was bleak: from the experience of China and Italy, it was clear that covid-19 was a highly infectious virus, with profound consequences for health, and for which there was no cure nor effective treatments. This meant that the only tools available to affect the spread of the pandemic were isolating people who had contracted the virus and their contacts, and, more generally restricting contacts between people, collectively known as non-pharmaceutical interventions, or NPIs.
Department for Science, Innovation and Technology
Department of Health and Social Care
The veil of ignorance through which the UK viewed the initial weeks of the pandemic...
Recommendation · source text
The veil of ignorance through which the UK viewed the initial weeks of the pandemic was partly self-inflicted. As we examine in depth in Chapter 4, the UK failed to turn an early lead in developing a test for covid in January 2020 into a testing operation that was adequate for the needs of the country—depriving scientists and policymakers of crucial granular data. Our Committees heard that the UK did not take enough advantage of the learning and experience being generated in other countries, notably in East Asia.98 The approach the UK took was particular, and in some respects exceptional.
Department for Science, Innovation and Technology
Department of Health and Social Care
The initial UK policy was to take a gradual and incremental approach to introducing non-pharmaceutical...
Conclusion · source text
The initial UK policy was to take a gradual and incremental approach to introducing non-pharmaceutical interventions. A comprehensive lockdown was not ordered until 23 March 2020—two months after SAGE first met to consider the national response to covid- 19.99 This slow and gradualist approach was not inadvertent, nor did it reflect bureaucratic delay or disagreement between Ministers and their advisers. It was a deliberate policy— proposed by official scientific advisers and adopted by the Governments of all of the nations of the United Kingdom.100 It is now clear that this was the wrong policy, and that it led to a higher initial death toll than would have resulted from a more emphatic early policy. In a pandemic spreading rapidly and exponentially every week counted. The former SAGE participant Professor Neil Ferguson told the Science and Technology Committee that if the national lockdown had been instituted even a week earlier “we would have reduced the final death toll by at least a half”.101
Department for Science, Innovation and Technology
Department of Health and Social Care
As a result, decisions on lockdowns and social distancing during the early weeks of the...
Recommendation · source text
As a result, decisions on lockdowns and social distancing during the early weeks of the pandemic—and the advice that led to them—rank as one of the most important public health failures the United Kingdom has ever experienced. This happened despite the UK 97 GOV.UK, ‘Precautionary SAGE 1 minutes: Coronavirus (COVID-19) response, 22 January 2020’, accessed 17 August 2021 98 See, for example: Q114, Q473, Q716, Q746 and Q1227 99 GOV.UK, ‘Prime Minister’s statement on coronavirus (COVID-19): 23 March 2020’, accessed 17 August 2021 100 See, for example: On 16 March SAGE advised “that there is clear evidence to support additional social distancing measures be introduced as soon as possible”—GOV.UK, ‘SAGE 16 minutes: Coronavirus (COVID-19) response, 16 March 2020’, accessed 17 August 2021 101 Oral evidence taken before the Science and Technology Committee on 10 June 2020, HC (2019–21) 136, Q883 Coronavirus: lessons learned to date 33 counting on some of the best expertise available anywhere in the world, and despite having an open, democratic system that allowed plentiful challenge. Painful though it is, the UK must learn what lessons it can of why this happened if we are to ensure it is not repeated. The initial policy: flattening the peak
Department for Science, Innovation and Technology
Department of Health and Social Care
There has been considerable debate as to whether the early policy of the Government was...
Conclusion · source text
There has been considerable debate as to whether the early policy of the Government was one of seeking to achieve so-called “herd-immunity”. The US Centres for Disease Control and Prevention defines community immunity/herd immunity as: A situation in which a sufficient proportion of a population is immune to an infectious disease (through vaccination and/or prior illness) to make its spread from person to person unlikely. Even individuals not vaccinated (such as newborns and those with chronic illnesses) are offered some protection because the disease has little opportunity to spread within the community. Also known as herd immunity.102
Department for Science, Innovation and Technology
Department of Health and Social Care
Non-pharmaceutical interventions such as lockdowns, and the testing and isolation of covid cases and their...
Conclusion · source text
Non-pharmaceutical interventions such as lockdowns, and the testing and isolation of covid cases and their contacts, are tools of temporary application. Once they are lifted, there is nothing to stop transmission resuming. When Sir Patrick Vallance said at a Government press conference on 12 March 2020 “it’s not possible to stop everybody getting it and it’s also actually not desirable because you want some immunity in the population. We need to have immunity to protect ourselves from this in the future”103 he was, in a sense, merely stating what were thought to be the facts of the time. Sir Patrick, and Ministers, have insisted that this statement was not a policy to seek herd immunity but a description of the situation. Matt Hancock wrote, as Secretary of State, on 14 March 2020: We have a plan, based on the expertise of world-leading scientists. Herd immunity is not a part of it. That is a scientific concept, not a goal or a strategy. Our goal is to protect life from this virus, our strategy is to protect the most vulnerable and protect the NHS through contain, delay, research and mitigate.104
Department for Science, Innovation and Technology
Department of Health and Social Care
From our evidence this appears to have led to a policy approach of fatalism about...
Conclusion · source text
From our evidence this appears to have led to a policy approach of fatalism about the prospects for covid in the community: seeking to manage, but not suppress, infection. This amounted in practice to accepting that herd immunity by infection was the inevitable outcome, given that the United Kingdom had no firm prospect of a vaccine, limited testing capacity and there was a widespread view that the public would not accept a lockdown for a significant period.105 That said, an initial unwillingness to consider seriously and act on the approach being taken in Taiwan, Singapore or Korea was a serious error. But even without an effective test and trace system earlier, social distancing and locking down would have bought much-needed time: time for vaccine research to bear fruit; time for treatments to be developed that could mean that experiencing covid-19 was less serious; time for test and trace systems to be developed and made effective so that the prevalence of the disease could be lowered without the entire population being restricted. The loss of 102 US Centres for Disease Control and Prevention, ‘glossary’, accessed 17 September 2021 103 10 Downing Street YouTube Channel, ‘UK Prime Minister Boris Johnson holds a press conference on coronavirus: 12 March 2020’, timestamp 10:43, accessed 17 August 2021 104 The Telegraph, We must do everything in our power to protect lives, Matt Hancock, 14 March 2020 105 See paragraphs 108–111 34 Coronavirus: lessons learned to date that time was to prove fatal to many. It would, however, be an overstatement to say that the Government and its advisers were promoting the acquisition of covid-19 to accelerate herd immunity in the population. But, in early Spring 2020, given that no alternative strategy was being implemented, that was the effective consequence. It was principally the threat of the NHS being overwhelmed that forced—belatedly—a change in direction.
Department for Science, Innovation and Technology
Department of Health and Social Care
So in the absence of a vaccine or an effective treatment being available at first,...
Conclusion · source text
So in the absence of a vaccine or an effective treatment being available at first, the UK faced a choice of doing everything possible to halt the virus, or seeking instead to moderate the pace of its spread. The UK chose the latter.106
Department for Science, Innovation and Technology
Department of Health and Social Care
Even as late as 12 March 2020, as noted in paragraph 80, Sir Patrick Vallance,...
Conclusion · source text
Even as late as 12 March 2020, as noted in paragraph 80, Sir Patrick Vallance, Government Chief Scientific Adviser, told a Government press conference that it was not possible to stop everyone being infected, and nor was that a desirable objective. The following day in a media interview Sir Patrick said that the aim of policy was: To try and reduce the peak, broaden the peak, not to suppress it completely. Also, because most people, the vast majority of people, get a mild illness, to build up some degree of herd immunity as well so that more people are immune to this disease and we reduce the transmission at the same time we protect those who are most vulnerable from it. Those are the key things we need to do.107 This reflected the views of the 23 people who participated in the SAGE meeting on 13 March, where the Group “was unanimous that measures seeking to completely suppress spread of Covid-19 will cause a second peak.”108 In practice this meant that social distancing policies were introduced gradually over a period of weeks.
Department for Science, Innovation and Technology
Department of Health and Social Care
The Government’s action plan of 3 March indicated that there was no intention to bring...
Conclusion · source text
The Government’s action plan of 3 March indicated that there was no intention to bring in a lockdown as strict as had been implemented in some other parts of the world. The action plan, under the heading ‘the Delay phase - next steps’ said: Action that would be considered could include population distancing strategies (such as school closures, encouraging greater home working, reducing the number of large-scale gatherings) to slow the spread of the disease throughout the population, while ensuring the country’s ability to continue to run as normally as possible.109 That approach meant that events that may have spread the virus proceeded—such as the football match between Liverpool FC and Atletico Madrid on 11 March—the day the coronavirus was categorised as a pandemic by the WHO—with a reported crowd of over 50,000110 and the Cheltenham Festival of Racing between 10 and 13 March, attracting more than 250,000 people.111 Subsequent analysis suggested that there were an additional 106 Evidence to the Science and Technology Committee in June 2020 from Professor Johan Giesecke, Former State Epidemiologist for Sweden and Professor Emeritus, Karolinska Institute, explained Sweden’s approach of a country asking individuals to change their behaviours without legislating for restrictions to be imposed. Q850 107 BBC Radio 4 Today, 13 March 2020—see Tweet by BBC Radio 4 Today (@BBCr4Today), 13/03/2020, 9.04am 108 GOV.UK, SAGE 15, 13 March 2020 109 GOV.UK, ‘Coronavirus: action plan’, accessed 17 September 2021 110 See, for example: ‘Liverpool vs Atletico Madrid: The Champions League match that should never have happened’, inews, 21 April 2020 111 ITV, ‘Coronavirus: Cheltenham festival and Liverpool Champions League game ‘likely increased suffering and death’’, 26 May 2020, accessed 2 September 2021 Coronavirus: lessons learned to date 35 37 and 41 deaths respectively at local hospitals after these events.112 However, it is not clear whether those deaths were as a result of atten
Department for Science, Innovation and Technology
Department of Health and Social Care
At its meeting of 5 March 2020, SAGE reconfirmed an explicitly gradual approach: There is...
Conclusion · source text
At its meeting of 5 March 2020, SAGE reconfirmed an explicitly gradual approach: There is epidemiological and modelling data to support implementation– within 1 to 2 weeks–of individual home isolation (symptomatic individuals to stay at home for 14 days) and whole family isolation (fellow household members of symptomatic individuals to stay at home for 14 days after last family member becomes unwell) to delay COVID-19 spread, modify the epidemic peak and reduce mortality rates. In addition, there is scientific data to support implementation–roughly 2 weeks later–of social isolation (cocooning) for those over 65 or with underlying medical conditions to delay spread, modify the epidemic peak and reduce mortality rates.113 SAGE had, however, considered advice to take a more robust precautionary approach. It received a paper, one of three, from the London School of Hygiene and Tropical Medicine on the considerations for non-pharmaceutical interventions. The paper said, with moderate confidence, that “NPIs that reduce transmission substantially should be introduced later but before the peak.”114 The same paper stated that: • Taking all into consideration, building up of NPIs in terms of intensity during the epidemic has many advantages: • It provides the opportunity for modification / improvement as we see the epidemic progress, i.e. it is robust to possible futures • It leaves room for policy modification during the epidemic, and avoids the situation in late summer if an epidemic has been curbed or greatly reduced that a larger epidemic is still expected.115
Department for Science, Innovation and Technology
Department of Health and Social Care
On 9 March 2020, SAGE set out a number of non-pharmaceutical interventions that could in...
Conclusion · source text
On 9 March 2020, SAGE set out a number of non-pharmaceutical interventions that could in due course be introduced by the Government. SAGE advised that “measures relating to individual and household isolation will likely need to be enacted within the next two weeks to be fully effective, and those concerning social distancing of the elderly and vulnerable 2–3 weeks after this”.116 On 12 March 2020, the Prime Minister said that anyone with a new continuous cough or a fever should self-isolate for seven days.117 Household isolation was announced on 16 March 2020.118 112 Edge Health, Understanding the role of large gatherings on the NHS, 28 May 2020. The analysis states that their findings cannot be used to establish causality 113 GOV.UK, SAGE 13, 5 March 2020 114 London School of Hygiene & Tropical Medicine, Considerations for NPI Policy – timing and sub-national targeting, 5 March 2020 115 London School of Hygiene & Tropical Medicine, Considerations for NPI Policy – timing and sub-national targeting, 5 March 2020 116 GOV.UK, Potential impact of behavioural and social interventions on an epidemic of Covid-19 in the UK, 9 March 2020 117 GOV.UK, ‘Prime Minister’s statement on COVID-19: 12 March 2020’, accessed 17 September 2021 118 GOV.UK, ‘Prime Minister’s statement on coronavirus (COVID-19): 16 March 2020’, accessed 17 September 2021 36 Coronavirus: lessons learned to date
Department for Science, Innovation and Technology
Department of Health and Social Care
It is striking, looking back, that it was accepted that the level of covid-19 infection...
Conclusion · source text
It is striking, looking back, that it was accepted that the level of covid-19 infection in the UK could be controlled by turning on particular non-pharmaceutical interventions at particular times. Indeed such was the belief in this ability to calibrate closely the response that a forward programme of interventions was published with the suggestion that they would be deployed only at the appropriate moment.119 In hindsight it seems a dubious and risky assumption to think that a new, unknown and rampant virus could be regulated in such a precise way. Even more so when—due to the early failure to establish a meaningful testing programme—the UK had very little data on the prevalence and spread of the virus across different settings and different groups of people.
Department for Science, Innovation and Technology
Department of Health and Social Care
This was not the only way to proceed, and indeed the UK was an outlier...
Conclusion · source text
This was not the only way to proceed, and indeed the UK was an outlier internationally in the gradualist approach that was being taken before late March.120 Countries in East Asia were the first to experience covid-19. Their response was a much more rapid and muscular imposition of social distancing and requirements to isolate.121
Department for Science, Innovation and Technology
Department of Health and Social Care
On 24 February the World Health Organisation published the report of its international mission to...
Conclusion · source text
On 24 February the World Health Organisation published the report of its international mission to Wuhan, and advised that countries should: (1) Immediately activate the highest level of national Response Management protocols to ensure the all-of-government and all-of-society approach needed to contain COVID-19 with non-pharmaceutical public health measures; (2) Prioritize active, exhaustive case finding and immediate testing and isolation, painstaking contact tracing and rigorous quarantine of close contacts122 The same report identified the virus as highly contagious, and with a prima facie case fatality rate of 3.8%, rising to over 20% among over 80s.123
Department for Science, Innovation and Technology
Department of Health and Social Care
In evidence to the Science and Technology Committee on 25 March 2020, the Editor of...
Conclusion · source text
In evidence to the Science and Technology Committee on 25 March 2020, the Editor of The Lancet, Dr Richard Horton, said that his journal had published articles on 24, 29 and 31 January with an analysis of the situation in China.124 He told the Committee: Those papers were truly alarming and showed that the disease caused a serious fatal pneumonia. A third of patients who had been reported in those papers required admission to the intensive care unit. The number of deaths that were being described was rising quickly. The authors of the papers were advocating the immediate provision of personal protective equipment and were urging the importance of testing and isolation. They were describing the fact that there was no effective treatment and also emphasising the pandemic potential. 119 GOV.UK, SAGE 12, Potential impact of behavioural and social interventions on an epidemic of Covid-19 in the UK, 9 March 2020 120 See footnote 108 121 See, for example: Q113, Q119 and Q474. 122 World Health Organisation, Report of the WHO-China Joint mission on Coronavirus Disease 2019 (COVID-19): 16–24 February 2020, p21 123 These were estimates of the fatality rate of covid-19 in February 2020 124 Oral evidence taken before the Science and Technology Committee on 25 March 2020, HC (2019–21) 136, Q39 Coronavirus: lessons learned to date 37 Those were the people from the frontlines of the epidemic at the end of January. Many of us at The Lancet felt that that was a red flag. We have had seven to eight weeks since that time, and February was the opportunity for the UK to really prepare, based on testing, isolation, quarantine, physical distancing, ICU capacity and so on. I think you described it as being critical and, yes, it was, in the sense that we missed that opportunity. We could have used the month of February, based on what we knew in January. When I look at the evidence that SAGE posted on the website—there is a lot of evidence and it is great that they have been so transparent—wh
Department for Science, Innovation and Technology
Department of Health and Social Care
The UK policy was to change abruptly.
Conclusion · source text
The UK policy was to change abruptly. During the days before 23 March, multiple people within the Government and its advisers experienced simultaneous epiphanies that the course the UK was following was wrong, possibly catastrophically so. In his evidence to our inquiry Dominic Cummings told us: On Friday the 13th [of March 2020], we then started to look through all the information and we started to pick apart all the different graphs. Ben [a No. 10 Specialist Adviser] spoke to Patrick; Patrick said, “I am also extremely concerned. It seems that something has gone fundamentally wrong in the wiring of the system. We have these graphs showing that even on the best- case scenario with the official plan, you are going to completely smash through the capacity of the NHS—not by a little bit but multiple times.” The evening of Friday the 13th, I am sitting with Ben Warner and the Prime Minister’s Private Secretary in the Prime Minister’s study. We were basically saying that we are going to have to sit down with the Prime Minister tomorrow and explain to him that we think that we are going to have to ditch the whole official plan, and we are heading for the biggest disaster this country has seen since 1940.127 125 Oral evidence taken before the Science and Technology Committee on 25 March 2020, HC (2019–21) 136, Q39 126 BBC, “Coronavirus: Italy extends emergency measures nationwide”, 10 March 2020; BBC, “Coronavirus: Spain set to declare national lockdown”, 14 March 2020; Metro, “ Netherlands becomes latest country to go into lockdown in battle against coronavirus”, 15 March 2020; France24, “Macron announces 15-day lockdown in French ‘war’ on coronavirus”, 16 March 2020 127 Q1003 38 Coronavirus: lessons learned to date Mr Cummings went on to tell us that other senior officials were recognising that the UK’s approach and epidemiological trajectory was on course for a “disaster”: At this point, the second most powerful official in the country, Helen MacNamara—the Deputy Cabin
Department for Science, Innovation and Technology
Department of Health and Social Care
In evidence to the Science and Technology Committee in July 2020, Sir Patrick Vallance, said...
Conclusion · source text
In evidence to the Science and Technology Committee in July 2020, Sir Patrick Vallance, said that SAGE advised the Government to implement the remainder of the menu of options for social distancing measures—in essence a full lockdown—on 16 or 18 March 2020: When the SAGE sub-group on modelling, SPI-M, saw that the doubling time had gone down to three days, which was in the middle of March, that was when the advice SAGE issued was that the remainder of the measures should be introduced as soon as possible. I think that advice was given on 16 or 18 March, and that was when those data became available. Looking 128 Q1003 129 Q1006 130 Q1293 Coronavirus: lessons learned to date 39 back, you can see that the data may have preceded that, but the data were not available before that. Knowledge of the three-day doubling rate became evident during the week before.131 On 16 March 2020, SAGE minutes show that the group concluded that additional measures, beyond those already in place, were required: “SAGE advises that there is clear evidence to support additional social distancing measures be introduced as soon as possible”.132 Sir Patrick explained that SAGE changed its advice on the basis that case numbers were doubling every three days, which was quicker than initially thought.133 Moreover, at the same meeting, SAGE considered a paper from Imperial College London academics, Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand.134 The paper concluded that “in an unmitigated epidemic, we would predict approximately 510,000 deaths in GB and 2.2 million in the US, not accounting for the potential negative effects of health systems being overwhelmed on mortality.”135 It was widely reported that this paper was a key factor in the Government’s decision to impose a full lockdown.136 SPI-M-O had also produced a consensus view that “general social distancing and school closures to case isolation, household isolation and social distancing o
Department for Science, Innovation and Technology
Department of Health and Social Care
It seems astonishing looking back that—despite the documented experiences of other countries; despite the then...
Conclusion · source text
It seems astonishing looking back that—despite the documented experiences of other countries; despite the then Secretary of State referring to data with a Reasonable Worst Case Scenario of 820,000 deaths;138 despite the raw mathematics of a virus which, if it affected two-thirds of the adult population and if one percent of people contracting it died would lead to 400,000 deaths—it was not until 16 March that SAGE advised the Government to embark on a full lockdown (having said on 13 March that “it was unanimous that measures seeking to completely suppress the spread of covid-19 will cause a second peak”)139 and not until 23 March that the Government announced it. Border controls
Department for Science, Innovation and Technology
Department of Health and Social Care
The UK did not impose blanket or rigorous border controls at the onset of the...
Conclusion · source text
The UK did not impose blanket or rigorous border controls at the onset of the covid-19 pandemic as compared to other countries, particularly in East and South East Asia.140 Instead, the UK implemented light-touch border controls only on countries and regions where there was a recorded high incidence rate. While the UK initially focused on China, Iran, South Korea and Italy, a significant number of cases came from elsewhere. A 131 Oral evidence taken before the Science and Technology Committee on 16 July 2020, HC (2019–21) 136, Q1079 132 GOV.UK, SAGE 16, 16 March 2020 133 Oral evidence taken before the Science and Technology Committee on 16 July 2020, HC (2019–21) 136, Q1079 134 Imperial College COVID-19 Response Team, Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand, 16 March 2020 135 Imperial College COVID-19 Response Team, Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand, 16 March 2020 136 For example, see: Financial Times, ‘The shocking coronavirus study that rocked the UK and US’ 137 GOV.UK, SPI-M-O: consensus view on behavioural and social interventions, 16 March 2020 138 See paragraph 91. 139 GOV.UK, SAGE 15, 13 March 2020 140 For example, on 28 January 2020, all inbound travellers from Wuhan were subject to isolation; from 26 February 2020, Singapore banned all arrivals from Cheongdo and Daegu in South Korea; from 3 February 2020, Hong Kong began to close border crossing posts. 40 Coronavirus: lessons learned to date study found that 33% of cases during the first wave were introduced from Spain and 29% were introduced from France.141 The number of seeding events that occurred early in the pandemic, coupled with the lack of data, made the lockdown almost inevitable.
Department for Science, Innovation and Technology
Department of Health and Social Care
By contrast, other countries implemented more rigorous border controls which were more effective at suppressing...
Conclusion · source text
By contrast, other countries implemented more rigorous border controls which were more effective at suppressing the virus and preventing the need for long and repeated lockdowns. However, even though it is not straightforward to make direct comparisons between countries, and it is yet to be seen how countries like New Zealand will fare when their borders are opened, it is reasonable to say that a more precautionary approach would have been beneficial at the start of the pandemic. Reasons for the delay in full lockdown
Department for Science, Innovation and Technology
Department of Health and Social Care
In the paragraphs that follow we consider some of the potential explanations of why the...
Conclusion · source text
In the paragraphs that follow we consider some of the potential explanations of why the initial decision-making on lockdowns was wrong, and what lessons can be drawn for the future from this. Should the Government have unilaterally taken a precautionary view in the first weeks, despite the SAGE advice?
Department for Science, Innovation and Technology
Department of Health and Social Care
The UK’s structure of scientific advice in emergencies, in which a group is formed of...
Conclusion · source text
The UK’s structure of scientific advice in emergencies, in which a group is formed of relevant experts (SAGE) to advise the Government is a prominent feature of our arrangements—much more so than in many other countries. Initially, participation in SAGE was not disclosed, nor the papers on which its advice drew, nor the minutes of its meetings. Following pressure, including from the House of Commons Science and Technology Committee, and supported by the Government Chief Scientific Adviser Sir Patrick Vallance,142 details of papers considered by SAGE were published from 20 March 2020; the individuals participating in SAGE were published from 4 May 2020; and minutes from 29 May 2020.143 Publication revealed that SAGE comprised a large number of scientific experts of high standing—over 85 individuals are listed as having participated in SAGE since its first meeting during the pandemic.144
Department for Science, Innovation and Technology
Department of Health and Social Care
SAGE provides advice to Ministers, whose responsibility it is to make policy decisions.
Conclusion · source text
SAGE provides advice to Ministers, whose responsibility it is to make policy decisions. However, witnesses to our Committees confirmed that during the early months of the pandemic the Government acted on the scientific advice it was given. Sir Patrick Vallance, for example, told the Science and Technology Committee on 25 March 2020 that there had been no significant disagreement between the Government and its scientific advisers on anything material.145
Department for Science, Innovation and Technology
Department of Health and Social Care
We accept that it is difficult for Ministers to go against a scientific consensus among...
Conclusion · source text
We accept that it is difficult for Ministers to go against a scientific consensus among the body set up to provide scientific advice during a national emergency. We also understand the reluctance to introduce measures with significant negative economic impact. But the 141 Imperial College London, ‘COVID-19 transmission chains in the UK traced back to Spain, France and Italy’, accessed 17 September 2021 142 Rt Hon Greg Clark MP, Chair, Science and Technology Committee (Qq75–76); Correspondence from the Chair to Sir Patrick Vallance, Chief Scientific Adviser, relating to SAGE Membership, 30 March 2020; and correspondence from Sir Patrick Vallance, Chief Scientific Adviser, relating to transparency of scientific evidence: social distancing, 28 May 2020 143 Science and Technology Committee, First Report of Session 2019–21, The UK response to covid-19: use of scientific advice, HC 136, paragraphs 55 and 71–72 144 GOV.UK, ‘List of participants of SAGE and related sub-groups’, accessed 17 August 2021 145 Oral evidence taken before the Science and Technology Committee on 25 March 2020, HC (2019–21) 136, Q81 Coronavirus: lessons learned to date 41 early weeks of the pandemic expose deficiencies in both scientific advice and Government action. In the early days of an emergency, formulating the best scientific advice is challenging: there are, for example, inevitable lags in acquiring and analysing data. Other countries took early decisions that were more seen as those of Government leaders rather than from established scientific evidence146 and it is possible that this provided a greater licence to take decisions more quickly, and on a more precautionary basis than happened in the UK—contributing to better overall outcomes. Was there sufficient challenge to scientific advice during the first weeks?
Department for Science, Innovation and Technology
Department of Health and Social Care
Several witnesses to our inquiry, reflecting on the early weeks of the pandemic, were rueful...
Conclusion · source text
Several witnesses to our inquiry, reflecting on the early weeks of the pandemic, were rueful that they did not sufficiently question and challenge the advice they were being given. We heard that challenging an established scientific consensus was difficult. Dominic Cummings told us: It was clear through all the meetings with PHE and everybody that everything was going wrong; everything we pushed, everything we probed—everything was wrong, bad, terrible. But I was incredibly frightened—I guess is the word—about the consequences of me kind of pulling a massive emergency string and saying, “The official plan is wrong, and it is going to kill everyone, and you’ve got to change path,” because what if I’m wrong? What if I persuade him [the Prime Minister] to change tack and that is a disaster? Everyone is telling me that if we go down this alternative path, it is going to be five times worse in the winter, and what if that is the consequence?147
Department for Science, Innovation and Technology
Department of Health and Social Care
The then Secretary of State, Matt Hancock MP, made the same point regarding the difficulty...
Conclusion · source text
The then Secretary of State, Matt Hancock MP, made the same point regarding the difficulty of challenging a scientific consensus.148 On 28 January 2020, SAGE said that testing asymptomatic individuals would “not be useful”.149 However, at the same meeting, SAGE went on to say that there was “limited evidence of asymptomatic transmission, but early indications imply some is occurring.”150 Matt Hancock told us that he thought asymptomatic transmission was occurring, but he found it difficult to challenge the scientific consensus: I was in a situation of not having hard evidence that a global scientific consensus of decades was wrong but having an instinct that it was. I bitterly regret that I did not overrule that scientific advice at the start and say that we should proceed on the basis that there is asymptomatic transmission until we know there is not, rather than the other way round. But when you are faced with a global consensus, and you do not have the evidence that you are right and the scientific consensus is wrong, it is hard to do that.151 146 For example, see “Coronavirus cases have dropped sharply in South Korea. What’s the secret to its success?”, 17 March 2020; and comments by Prof Balloux and Dr Groppelli, 10 March 2020 147 Q1008 148 Q1302 149 GOV.UK, SAGE 2, paragraph 16, 28 January 2020 150 GOV.UK, SAGE 2, paragraph 16, 28 January 2020 151 Q1302 42 Coronavirus: lessons learned to date We also note that Nobel Laureates Sir Paul Nurse and Sir Peter Ratcliffe wrote to the then Secretary of State to warn about asymptomatic transmission and the need for testing in April 2020. However, they did not receive a substantive response until July and only then from a correspondence clerk rather than the then Secretary of State.152 We continue to await a response from the Department on why action was not taken on asymptomatic transmission and testing earlier.153
Department for Science, Innovation and Technology
Department of Health and Social Care
We accept that it is difficult to challenge a widely held scientific consensus.
Recommendation · source text
We accept that it is difficult to challenge a widely held scientific consensus. But accountability in a democracy depends on elected decision-makers taking advice, but examining, questioning and challenging it before making their own decisions. We find it surprising that the fatalistic assumptions behind the initial scientific advice were not challenged until it became clear the NHS could be overwhelmed, particularly given alternative strategies were being pursued visibly and successfully in East Asian countries. We heard that ‘red teaming’ and structured challenge was used within the national security community, which may also be of benefit to the scientific community.154 Kate Bingham also pointed out that the Government may have benefited from more scientists within the Civil Service155 We acknowledge that the then Secretary of State told us that he had challenged scientific advice regarding asymptomatic transmission.156 However, this came after the key moments in mid-March when challenge was needed most, and after the WHO had warned of asymptomatic transmission. The influence of modelling during the pandemic
Department for Science, Innovation and Technology
Department of Health and Social Care
In his evidence to the Science and Technology Committee during the early weeks of the...
Conclusion · source text
In his evidence to the Science and Technology Committee during the early weeks of the pandemic, on 25 March, the Editor of the Lancet expressed concern that mathematical modelling was playing too influential a role in UK scientific advice.157 The prominence of modelling and projections was, and still remains, an important part of the UK’s response to covid-19. Models can be useful and informative to policymakers, but they come with limitations. As Professor Neil Ferguson told the Science and Technology Committee in June 2020, “Models can only be as reliable as the data that is feeding into them.”158 However, we know that—especially in the early stages of the pandemic—there was an acute shortage of good data.159 There was also a limited understanding of the virus early in the pandemic. Key questions, such as the length of immunity conferred by infection, were unknown and hampered accurate modelling.160
Department for Science, Innovation and Technology
Department of Health and Social Care
Evidence to the Science and Technology Committee from other academic disciplines included scepticism of the...
Conclusion · source text
Evidence to the Science and Technology Committee from other academic disciplines included scepticism of the weight being placed on mathematical models during the pandemic. For example Professor Sir John Kay, Economist and Fellow in Economics, St 152 Correspondence from Rt Hon Greg Clark and Rt Hon Jeremy Hunt to Matt Hancock, 22 June 2021 153 After the Report was agreed by the Committees a response from Rt Hon Sajid Javid MP, Secretary of State for Health and Social Care, was received. 154 Q743 155 Oral evidence taken before the Science and Technology Committee on 4 November 2020, HC (2019–21) 136, Q282 156 Q1300 157 See, for example: oral evidence taken before the Science and Technology Committee on 25 March 2020, HC (2019–21) 136, Q40 and Q42. 158 Oral evidence taken before the Science and Technology Committee on 10 June 2020, HC (2019–21) 136, Q889 159 For example, see: SAGE 14, 10 March 2020, paragraph 36 160 Oral evidence taken before the Science and Technology Committee on 10 June 2020, HC (2019–21) 136, Q841 Coronavirus: lessons learned to date 43 John’s College, University of Oxford, told the Science and Technology Committee in June 2020 that models did not necessarily respond well to change and should not be used to make predictions: economic models tend to work pretty well as long as nothing much changes, which does not help them to be a great deal of use. What really matters from this point of view is understanding the nature of the underlying change. […] In my view, the use of economic models and other models is not so much to make predictions as to give people better insights into what is going on, and that is the way in which models ought to be used.161 Professor Carol Propper, Professor of Economics, Imperial College London and President of the Royal Economic Society, illustrated that assumptions in models had not always borne out and there was a need for up-to-date data: To give one more example of the need for that data, when we shut down hospitals
Department for Science, Innovation and Technology
Department of Health and Social Care
Sir John also highlighted concerns about how different academic disciplines did not collaborate sufficiently on...
Conclusion · source text
Sir John also highlighted concerns about how different academic disciplines did not collaborate sufficiently on models.164 Professor James Poterba, Mitsui Professor of Economics, Massachusetts Institute of Technology, explained to the Science and Technology Committee that the consequence of this was that some costs were not factored into models earlier in the pandemic: Many in epidemiology and in the health services area have realised that the economic cost of some of the policies their models suggested were very important to understand, and consequently they have become very concerned about building some more economics into those models in various ways.165 161 Oral evidence taken before the Science and Technology Committee on 5 June 2020, HC (2019–21) 136, Qq764– 765 162 Oral evidence taken before the Science and Technology Committee on 5 June 2020, HC (2019–21) 136, Q774 163 Oral evidence taken before the Science and Technology Committee on 5 June 2020, HC (2019–21) 136, Q768 164 Oral evidence taken before the Science and Technology Committee on 5 June 2020, HC (2019–21) 136, Q767 165 Oral evidence taken before the Science and Technology Committee on 5 June 2020, HC (2019–21) 136, Q770 44 Coronavirus: lessons learned to date
Department for Science, Innovation and Technology
Department of Health and Social Care
Professor Chris Whitty noted that he preferred advice to be given on the basis of...
Conclusion · source text
Professor Chris Whitty noted that he preferred advice to be given on the basis of observed data, telling the Science and Technology Committee in November 2020: “It is important to say that a lot of the advice that I have given is not based on significant forward modelling. It is based on what is happening and what is observable.”166
Department for Science, Innovation and Technology
Department of Health and Social Care
Yet despite this, throughout the pandemic, detailed modelled projections have assumed a great prominence and...
Conclusion · source text
Yet despite this, throughout the pandemic, detailed modelled projections have assumed a great prominence and have evidently had great influence on Government decisions. Indeed, the publication of the Imperial study of 16 March, is often cited as one of the main triggers for the abandonment of the initial policy of flattening the peak of covid, and its replacement with the one of suppression, in line with many other countries.167 Assumptions about behavioural compliance
Department for Science, Innovation and Technology
Department of Health and Social Care
Another potential reason for the late lockdown was the behavioural advice that was being tendered...
Conclusion · source text
Another potential reason for the late lockdown was the behavioural advice that was being tendered to the Government. Behavioural advice is tendered to the Government through SAGE’s sub-group, the Scientific Pandemic Insights Group on Behaviours (SPI- B).168 SPI-B’s first publicly known input into SAGE was on 25 February 2020 on the risk of public disorder.169
Department for Science, Innovation and Technology
Department of Health and Social Care
The initial action plan did not consider the possibility of ceasing all non-essential contact.
Conclusion · source text
The initial action plan did not consider the possibility of ceasing all non-essential contact. Dominic Cummings told us that the idea of behavioural fatigue was a part of “false groupthink”: One of the critical things that was completely wrong in the whole official thinking in SAGE and in the Department of Health in February/March was, first of all, the British public would not accept a lockdown and, secondly, the British public would not accept what was thought of as an east Asian-style track and trace-type system and the infringements of liberty around that.170 The then Secretary of State for Health and Social Care also indicated to us in June 2021 that “the clear advice at the time was that there was only a limited period that people would put up with it—would put up with lockdown.”171 On 9 March 2020, Professor Chris Whitty told a Government press conference: It is not just a matter of what you do but when you do it. Anything we do, we have got to be able to sustain. Once we have started these things we have to continue them through the peak and that is for a period of time, and there is a risk that, if we go too early, people will understandably get fatigued and it will be difficult to sustain this over time.172 Further, on 10 March 2020, SAGE said that: 166 Oral evidence taken before the Science and Technology Committee on 3 November 2020, HC (2019–21) 136, Q1438 167 Imperial College London, Report 9—impact on non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand, 16 March 2020; and BBC News, ‘Coronavirus: UK changes course amid death toll fears’, accessed 17 September 2021 168 GOV.UK, ‘List of participants of SAGE and related sub-groups’, accessed 17 September 2021 169 SPI-B, Risk of public disorder, 25 February 2020 170 Q1002 171 Q1294 172 10 Downing Street YouTube channel, PM Boris Johnson holds a press conference on coronavirus: 9 March 2020, timestamp 8:04, accessed 17 September 2021 Coronavirus: lessons learned to dat
Department for Science, Innovation and Technology
Department of Health and Social Care
It transpired that the UK public were very compliant with the eventual lockdown measures.175 Professor...
Conclusion · source text
It transpired that the UK public were very compliant with the eventual lockdown measures.175 Professor Chris Whitty also said in November 2020: Across the board, my reflection is that the great majority of people—and this is reflected in all the polling and a variety of other things—both intend to stick to the rules and do stick to the rules to a remarkable degree. To go back to Patrick’s point, were that not the case, we would be in a massively worse place than we are at the moment. My expectation is that R would have shot right up if people had not massively reduced the number of people they have contact with, had not stuck to all the things we need to do in individual actions they can take—such as hands, face and space—and businesses had not done a huge amount to try to make them Covid secure. Without that, we would be in a very difficult place compared with where we are now.176
Department for Science, Innovation and Technology
Department of Health and Social Care
The restrictions eventually imposed on the UK public because of the pandemic were unprecedented.
Conclusion · source text
The restrictions eventually imposed on the UK public because of the pandemic were unprecedented. Even in wartime there had been no equivalent of the order to make it a criminal offence for people to meet each other and to remain in their homes other than for specified reasons. In advance, it may not have been unreasonable to assume that the public would have a limited tolerance of such draconian restrictions. But that assumption turned out to be wrong. In the event, compliance with social distancing measures was at a level and for a duration beyond what was anticipated. If a belief that people would not comply delayed a full lockdown, and caused an initially limited set of non-pharmaceutical interventions to be adopted, this was a poor guide to policy. Was scientific advice sufficiently internationally diverse?
Department for Science, Innovation and Technology
Department of Health and Social Care
We have referred to early evidence from Dr Richard Horton, the Editor of the Lancet,...
Conclusion · source text
We have referred to early evidence from Dr Richard Horton, the Editor of the Lancet, who was concerned that SAGE in its early months was taking insufficient account of international perspectives. At the time he gave his evidence, Dr Horton, like the rest of the public, was not aware of the membership of SAGE. Now we are, and it is notable that 173 GOV.UK, SAGE 14, 10 March 2020 174 GOV.UK, SAGE 16, 16 March 2020 175 Office for National Statistics, ‘Coronavirus and the social impacts on behaviours during different lockdown periods, Great Britain: up to February 2021’, accessed 17 September 2021 176 Oral evidence taken before the Science and Technology Committee on 3 November 2020, HC (2019–21) 136, Q1517 46 Coronavirus: lessons learned to date of the 87 people listed as having participated in at least one meeting of SAGE, all bar one person (Dr Pasi Penttinen, European Centre for Disease Prevention and Control) are from UK institutions.177
Department for Science, Innovation and Technology
Department of Health and Social Care
It is a characteristic of the best UK scientific institutions, and the people that work...
Conclusion · source text
It is a characteristic of the best UK scientific institutions, and the people that work in them, that much of their research involves extensive international collaboration. However, for a virus that has affected every country in the world and which was experienced first by other countries, it is also right to consider whether our scientific advisory bodies are sufficiently international. This question arises not only in the context of the early decisions on lockdown but, as we will see in Chapter 4, Public Health England’s failure to evidence any formal evaluation of the test and trace policies of countries which had experienced covid before the UK.
Department for Science, Innovation and Technology
Department of Health and Social Care
Dr Horton expressed concerns about the evidence base that SAGE in its early meetings drew...
Conclusion · source text
Dr Horton expressed concerns about the evidence base that SAGE in its early meetings drew upon. Referring to scientists in East Asia, Dr Horton told the Science and Technology Committee: If I had been Chair of SAGE, I would have wanted to go to those scientists on the frontline saying, “Please come and tell us your experience. What is coming for us in the UK? Why are you sending this warning signal?” because it is not there in the SAGE evidence.178 Local lockdowns: the tier system
Department for Science, Innovation and Technology
Department of Health and Social Care
Although introduced several weeks after it should have been, the national lockdown brought in on...
Conclusion · source text
Although introduced several weeks after it should have been, the national lockdown brought in on 23 March succeeded in reducing the incidence of covid across the country, so that from May 2020 national restrictions were eased. However, tougher restrictions were maintained in areas where infections were higher. For example, the City of Leicester remained in lockdown measures from July to September 2020.179 The North West of England had stubbornly high levels of covid throughout the summer, and restrictions were imposed on Liverpool, Greater Manchester, Blackburn, and eventually the whole of the region on 29 September 2020.180
Department for Science, Innovation and Technology
Department of Health and Social Care
The Government sought to agree with local leaders the package of restrictions that would apply...
Conclusion · source text
The Government sought to agree with local leaders the package of restrictions that would apply in particular areas. However, the consequence of this approach led to political differences between national government and some local leaders as to what measures were appropriate for their area—most prominently, the Greater Manchester Mayor, Andy Burnham, and the Government being in a state of disagreement for 10 days during October before restrictions were imposed unilaterally.181
Department for Science, Innovation and Technology
Department of Health and Social Care
By mid-September 2020, case rates were rising across the country, but there were significant local...
Conclusion · source text
By mid-September 2020, case rates were rising across the country, but there were significant local differences. For example, on 30 September, the incidence of covid ranged from 607 per 100,000 population per week in East Sussex, to 4,318 in Knowsley.182 To 177 GOV.UK, ‘List of participants of SAGE and related sub-groups’, accessed 17 August 2021. One participant, Dr Demis Hassabis, attended in a personal capacity, so we do not include them in our analysis. 178 Oral evidence taken before the Science and Technology Committee on 25 March 2020, HC (2019–21) 136, Q40 179 House of Lords Library, ‘Leicester lockdown: Changes since July 2020’, accessed 17 August 2021 180 House of Commons Library, Coronavirus: A history of English lockdown laws, 30 April 2021; Health Protection (coronavirus, Restrictions) (North of England, North East and North West of England and Obligations of Undertakings (England) etc.) (Amendment) Regulations 2020 (SI 2020/1057) 181 HC Deb, 20 October 2020, cols 1015–16 [Commons Chamber] 182 GOV.UK, Coronavirus (COVID-19) in the UK: 30 September 2020, web archive, accessed 17 August 2021 Coronavirus: lessons learned to date 47 rationalise the increasingly disparate sets of restrictions being imposed on different places, on 12 October 2020, the Prime Minister announced a three-tier system of local restrictions:183 • Tier 1 maintained the rule of six184 and a 10pm curfew for hospitality; • Tier 2 did not permit indoor gatherings (including hospitality) but allowed gatherings of up to six people in outdoor settings; and • Tier 3 a ban on household mixing and hospitality being closed. Retail, schools, and personal care remained open.
Department for Science, Innovation and Technology
Department of Health and Social Care
As we discuss in Chapter 4, there had been hopes that by Autumn 2020 an...
Conclusion · source text
As we discuss in Chapter 4, there had been hopes that by Autumn 2020 an effective test, trace and isolate system—promised to be “world-beating”—would allow covid levels to be contained without recourse to extensive lockdown restrictions. Indeed the business case that the Test and Trace organisation put forward for Treasury approval cited the enormous savings that would result from being able to avoid a second lockdown as justifying the expenditure of £12bn requested from the Exchequer in September 2020 (the budget and expenditure of Test and Trace subsequently increased).185 As with the early failure of the test and trace system in February and March 2020—then under PHE’s management—to be of material assistance in stopping the spread of the pandemic like in East Asian Countries, the national test and trace operation failed once again to deliver the contribution it promised to avoiding social distancing measures from being required to take up the strain.
Department for Science, Innovation and Technology
Department of Health and Social Care
The experience of the tiered system during the autumn was, however, unsatisfactory.
Conclusion · source text
The experience of the tiered system during the autumn was, however, unsatisfactory. In the absence of effective contact tracing, the regional restrictions proved not to be anywhere near watertight enough to prevent infections spreading, compounded by delays in getting test results. Professor John Edmunds, Professor of Infectious Disease Epidemiology and a participant of SAGE, told us that he had concerns about what the tiering system would result in and that he would not have followed such a strategy: What worries me a little bit is where the strategy leads at the moment. If you think it through, the targeted strategy—the tiered strategy—leads to a high level of incidence everywhere. Let’s say that tier 3 works and keeps the reproduction number at about 1. I do not think anybody really thinks it will reduce it to less than 1. Let’s assume that it manages to get the reproduction number to about 1. That means that in Liverpool, Manchester and the north-west, we will keep the incidence at that high level, which is putting hospitals under strain and causing significant numbers of deaths. We are going to keep it at that high level for the foreseeable future. 183 HC Deb, 12 October 2020, col 23 [Commons Chamber] 184 The ‘Rule of Six’ means that, apart from limited exemptions such as work and education, any social gatherings of more than six people will be against the law. For more, see: GOV.UK, Rule of six comes into effect to tackle coronavirus, 14 September 2020 185 National Audit Office, The government’s approach to test and trace in England—interim report, 11 December 2020, page 18 48 Coronavirus: lessons learned to date A few weeks later, the midlands goes into tier 3, so we then keep the midlands at a high level of incidence for the foreseeable future. London is shortly thereafter, and we keep London there. The logical extension of this means that we all end up at a high level of incidence, where hospitals are really under strain and we have large numbers of deaths.
Department for Science, Innovation and Technology
Department of Health and Social Care
Professor Dame Angela McLean, Chief Scientific Adviser to the Ministry of Defence and a participant...
Conclusion · source text
Professor Dame Angela McLean, Chief Scientific Adviser to the Ministry of Defence and a participant of SAGE, told the Science and Technology Committee in February 2021 that the tier system waited until prevalence was high before any action was taken, implying this was a flaw with the tier system: What we did with the tier system was we waited until prevalence—the number of people in a place—was high before putting it into a more restrictive tier. We should have said, “Ah, look, in this part of the country the number of infections is starting to grow”—we have a rather exquisite tool for measuring that—and put it into a higher tier while its prevalence was still low.187 Dame Angela’s point was also noted in SAGE minutes. On 19 November 2020, SAGE said that “evidence shows that the earlier and more rapidly interventions are put in place, and the more stringent they are, the faster the observed reduction in incidence and prevalence.”188
Department for Science, Innovation and Technology
Department of Health and Social Care
Another problem with the tiered restrictions that were implemented during the autumn of 2020 was...
Conclusion · source text
Another problem with the tiered restrictions that were implemented during the autumn of 2020 was that it was not fully clear what criteria would cause a particular area to be placed in a given tier, nor what would be required for it to exit a particular tier. At times, these decisions felt arbitrary and untransparent. The newly-formed Joint Biosecurity Centre was the source of data and analysis on which these important decisions were made. However, the Joint Biosecurity Centre is a particularly opaque organisation, lacking even the transparency that had come to be displayed eventually by SAGE.189 Dr Clare Gardiner, who was appointed Director of the Joint Biosecurity Centre in June 2020 (but who has now resigned from the post) told our inquiry: The sorts of data that we look at are case rates and positivity–the number of people who have tested positive–in different age groups. […] we are also looking keenly at the number of people being admitted to hospital.190
Department for Science, Innovation and Technology
Department of Health and Social Care
There has also been a lack of transparency over the scientific case for particular interventions.
Conclusion · source text
There has also been a lack of transparency over the scientific case for particular interventions. After the initial, broad lockdown had been lifted specific prohibitions were introduced in later months. Such restrictions were typically justified by Ministers as 186 Q164 187 Oral evidence taken before the Science and Technology Committee on 17 February 2021, HC (2019–21) 136, Q1990 188 GOV.UK, SAGE 69, 19 November 2020 189 Science and Technology Committee, First Report of Session 2019–21, The UK response to covid-19: use of scientific advice, HC 136, paragraphs 59–64. We note that since the publication of the Science and Technology Committee’s Report some information has been published by the JBC. Some of this was outlined in DHSC, ‘The Government’s Response to the Science and Technology Committee report: The UK Response to Covid-19: Use of Scientific Advice’, May 2021, CP 432 190 Q184 Coronavirus: lessons learned to date 49 being scientifically based. But supporting scientific reasoning and evidence was usually lacking. For example, no SAGE paper, or scientific evidence, was published to support the imposition from 24 September 2020 of a 10pm curfew on pubs—a decision that affected the livelihoods of many people in the hospitality sector.191
Department for Science, Innovation and Technology
Department of Health and Social Care
Scientific advice was cited in justification for increasingly fine-grained restrictions— with which some of the...
Conclusion · source text
Scientific advice was cited in justification for increasingly fine-grained restrictions— with which some of the Government’s scientific advisers were often visibly uncomfortable. When Sir Patrick Vallance, the Government Chief Scientific Adviser, was asked on 3 November why children’s outdoor sport was banned, despite by then widespread evidence that outdoor transmission of covid was very rare, Sir Patrick said: They have had advice from us in terms of the general principles and some of the areas, but, as I say, not down to individual specific activities like that, and the same is true on the medical side as well. […] Chair: Would you advise that children’s outdoor sports should banned? Sir Patrick Vallance: As Chris said, we just do not go down to that level of individual activities.192
Department for Science, Innovation and Technology
Department of Health and Social Care
The two months between September 2020 and 31 October 2020 were an unsatisfactory period in...
Conclusion · source text
The two months between September 2020 and 31 October 2020 were an unsatisfactory period in which the comparative simplicity of the rules in place from the evening of 23 March onwards were replaced by a complex, inconsistent, shifting and scientifically ambiguous set of detailed restrictions. The rules had previously been a matter of broad national consent, but that sense of national solidarity began to erode, as the uncomfortable stand-off in Greater Manchester showed. Proposed circuit breaker
Department for Science, Innovation and Technology
Department of Health and Social Care
Throughout September and October 2020, case numbers and hospitalisations continued to rise nationwide.
Conclusion · source text
Throughout September and October 2020, case numbers and hospitalisations continued to rise nationwide. As the virus started to spread and a second wave appeared to have started, SAGE advised on 21 September 2020 that a two week ‘circuit breaker’, a short and sharp lockdown, could return incidence to manageable levels.193 However, the Government resisted that advice and continued to take localised action. This was a key moment when the Government significantly diverged from the scientific advice it received. On 24 September 2020, SAGE said: SAGE previously advised that a 2 week ‘circuit-breaker’, where more stringent restrictions are put in place for a shorter period, could have additional impact. A shorter break of a week or less is likely to be less effective in reducing the number of infections and slowing the growth of the epidemic. 191 GOV.UK, ‘News story: Coronavirus (COVID-19): What has changed – 22 September’, accessed 17 August 2021. See also: Letter from the Chair of the Science and Technology Committee to Sir Patrick Vallance, Government Chief Scientific Adviser, dated 30 September 2020, and Sir Patrick’s response dated 13 October 2020; and Letter from the Chair of the Science and Technology Committee to the Secretary of State for Health and Social Care, Matt Hancock MP, dated 13 October 2020, and the Secretary of State’s response dated 16 October 2020. 192 Oral evidence taken before the Science and Technology Committee on 3 November 2020, HC (2019–21) 136, Qq1538–39 193 GOV.UK, SAGE 57, 17 September 2020 50 Coronavirus: lessons learned to date However, while a single circuit breaker has the potential to keep prevalence much lower than no intervention, it is not a long-term solution. Long-term control of the virus will likely require repeated circuit breaks, or for one to be followed by a longer-term period with measures in place to keep R at or below 1. Longer-term sustained measures will also be essential.194
Department for Science, Innovation and Technology
Department of Health and Social Care
In evidence to the Science and Technology Committee in November 2020, Sir Patrick Vallance added...
Conclusion · source text
In evidence to the Science and Technology Committee in November 2020, Sir Patrick Vallance added that the intention of the circuit breaker was to enable the test and trace system—which in September had once again been found to be inadequate—to be more effective: The advice in September was about a circuit breaker with the intention of driving the numbers back to how they were in August, going back to the discussion on test and trace, because that means you have a greater chance of test and trace being effective. That takes more of the load in managing the disease and you may have to do fewer in terms of other non-pharmaceutical interventions. That is the logic behind that suggestion […].195 Professor Chris Whitty suggested that the case for a circuit breaker was not conclusive, reflecting “there is a lot of uncertainty in these things.”196
Department for Science, Innovation and Technology
Department of Health and Social Care
Dominic Cummings told our inquiry that Downing Street held a meeting on 20 September 2020...
Recommendation · source text
Dominic Cummings told our inquiry that Downing Street held a meeting on 20 September 2020 for the Prime Minister to hear both sides of the argument. He explained that Professor John Edmunds put forward the view that the Government should impose another lockdown while Professors Gupta and Heneghan put forward an opposing view. Professor Gupta and Professor Heneghan have subsequently written to us to highlight their view regarding that meeting, including, in their view, that a number of claims that Dominic Cummings made about their presentation to the Prime Minister were incorrect.197 Following that meeting, Mr Cummings explained that the Prime Minister was not persuaded about the need to impose another national lockdown.198
Department for Science, Innovation and Technology
Department of Health and Social Care
It is impossible to know whether a circuit breaker would have had a material effect...
Conclusion · source text
It is impossible to know whether a circuit breaker would have had a material effect in preventing a second lockdown, given that such an approach was pursued in Wales, which still ended up having further restrictions in December 2020. But it seems that Ministers were mistaken in the weeks after the first wave abated in taking an optimistic assumption that the worst was behind us.199 The second lockdown
Department for Science, Innovation and Technology
Department of Health and Social Care
On 31 October 2020, the Prime Minister announced tougher nationwide restrictions in England—the second lockdown.200...
Conclusion · source text
On 31 October 2020, the Prime Minister announced tougher nationwide restrictions in England—the second lockdown.200 The UK public were once again told to “stay at 194 GOV.UK, SAGE 59, 24 September 2020 195 Oral evidence taken before the Science and Technology Committee on 3 November 2020, HC (2019–21) 136, Q1505 196 Oral evidence taken before the Science and Technology Committee on 3 November 2020, HC (2019–21) 136, Q1507 197 Professor Carl Heneghan (Director at Centre for Evidence-Based Medicine, Professor of Evidence-Based Medicine at University of Oxford); Professor Sunetra Gupta (Professor of Theoretical Epidemiology at University of Oxford) (CLL0117)) 198 Q1154 199 For example, the changing advice on working from home, the ‘eat out to help out’ scheme and Q1093. 200 GOV.UK, ‘Prime Minister’s statement on coronavirus (COVID-19): 31 October 2020’, accessed 17 September 2021 Coronavirus: lessons learned to date 51 home”. However, unlike the first lockdown, schools remained open. The Prime Minister announced the second lockdown to the House of Commons on 2 November (having announced it to the nation on 31 October), where he imposed a clear time limit on the lockdown: Let me stress that these restrictions are time limited. After four weeks, on Wednesday 2 December, they will expire, and we intend to return to a tiered system on a local and regional basis, according to the latest data and trends.201 On 2 December 2020, the second lockdown ended, and England went back into the three- tier system. However, case numbers remained high (at 14,879 on 3 December 2020)202 and started rising again. As a result, on 19 December 2020, the Prime Minister added a tier 4 to the tiering system.203 This followed the discovery of the new UK variant (B.1.1.7) of covid-19, or the “Alpha” variant.
Department for Science, Innovation and Technology
Department of Health and Social Care
The circumstances of the lockdown announced on 31 October were controversial.
Conclusion · source text
The circumstances of the lockdown announced on 31 October were controversial. A Downing Street press conference had been hastily convened on the Saturday evening following leak to newspapers of the Government’s likely intention to bring in a further lockdown.
Department for Science, Innovation and Technology
Department of Health and Social Care
At the press conference, modelling projections were presented which warned of a risk to the...
Conclusion · source text
At the press conference, modelling projections were presented which warned of a risk to the ability of the NHS to cope with likely hospital admissions unless the proposed measures were taken. Sir Patrick Vallance in evidence to the Science and Technology Committee on 3 November said: You would expect the number of hospitalisations to breach the first wave probably towards the end of November. You would expect the number of deaths, potentially, to equal, the first wave numbers sometime in mid- December.204
Department for Science, Innovation and Technology
Department of Health and Social Care
However, it emerged during the following days that the modelling that was presented at the...
Conclusion · source text
However, it emerged during the following days that the modelling that was presented at the press conference was based on data that had been superseded by more up-to-date information. It also emerged that the forecasts did not include the impact of the regional restrictions that had been brought in on 9 October.205 In practice, the advice of the Government’s most senior scientific advisers that the NHS was likely to be overwhelmed if the advised second lockdown was not imposed made it almost inevitable that it would go ahead: Chair: We come to the importance of the inquiries into these forecasts. Accepting that Ministers decide and advisers advise, in practice, if the advice from advisers to the Prime Minister is that the capacity of the NHS is likely to be overrun within weeks, that is quite difficult advice to gainsay, is it not? That is why there is an interest in understanding the basis of the advice. It is not optional advice in that sense, is it? 201 HC Deb, 2 November 2020, col 24 [Commons Chamber] 202 GOV.UK, ‘Coronavirus (COVID-19) in the UK’, accessed 22 June 2021 203 GOV.UK, ‘Prime Minister’s statement: 19 December 2020’, accessed 17 September 2021 204 Oral evidence taken before the Science and Technology Committee on 3 November 2020, HC (2019–21) 136, Q1438 205 See, for example: Correspondence from Ed Humpherson to Sir Patrick Vallance regarding transparency of data related to COVID-19, 5 November 2020 52 Coronavirus: lessons learned to date Sir Patrick Vallance: That was the forecasting from the NHS. That is what they said. Chair: It is also what you said. Sir Patrick Vallance: Yes. It is what we say from the modelling. As I said, we cannot deal with NHS capacity. I do not have insight into NHS capacity. Chair: But your advice to the Prime Minister and the Government, based on NHS data and the modelling data, was that this is a serious prospect and a serious risk. Sir Patrick Vallance: Yes.206 The Kent or ‘Alpha’ variant
Department for Science, Innovation and Technology
Department of Health and Social Care
Whilst it is clear the first lockdown was called too late, it is not however...
Conclusion · source text
Whilst it is clear the first lockdown was called too late, it is not however possible to make such a clear cut judgement about the second lockdown from 31 October for two reasons. First, since the advice was taken and lockdown measures were introduced, the counterfactual—what would have happened to infections, hospital admissions and deaths if the second lockdown had not been instigated—is unknowable. The second reason is that unknown to advisers at the time, a new variant of covid (B.1.1.7) which came to be described first as the Kent variant and later as the Alpha variant, was already transmitting within the population. We were eventually to learn that this variant was significantly more transmissible than the initial strain of covid-19.
Department for Science, Innovation and Technology
Department of Health and Social Care
Following genomic sequencing, PHE found that the Alpha variant first appeared in Kent in September...
Conclusion · source text
Following genomic sequencing, PHE found that the Alpha variant first appeared in Kent in September 2020 and rapidly became the dominant variant in Kent, and subsequently, the rest of England.207 The new variant was first brought to the attention of the Government on 11 December 2020.208 On 18 December, the Government was warned that the variant was significantly more transmissible than the initial strain of covid-19.209 The eventual knowledge of this new variant and its heightened transmissibility explained what had been observed earlier: that North Kent and neighbouring areas were experiencing unaccountably high and persistent levels of covid infections during the late autumn. For example, on 30 November 2020, the rate of confirmed covid-19 cases in Swale, in North Kent, was 568 per 100,000 population—over three times as high as the UK rate of 154 per 100,000.210
Department for Science, Innovation and Technology
Department of Health and Social Care
Leading virologists who gave evidence to the Science and Technology Committee on 23 December said...
Conclusion · source text
Leading virologists who gave evidence to the Science and Technology Committee on 23 December said that the Government had acted quickly in response to the new evidence. For example, Professor Peter Horby, Chair of the New and Emerging Respiratory Virus 206 Oral evidence taken before the Science and Technology Committee on 3 November 2020, HC (2019–21) 136, Qq1443–1445 207 GOV.UK, ‘COVID-19 (SARS-CoV-2): information about the new virus variant’, accessed 17 September 2021 208 Susan Hopkins, Strategic Response Director, COVID-19, PHE, explained in a media interview on 20 December that the Government was first notified of the new variant on 11 December: @RidgeonSunday Twitter, 20 December 2020, 12.53pm 209 Following work by modellers and academics, Dr Susan Hopkins explained to The Andrew Marr Show on 20 December that, a difference in transmissibility and infectiousness was identified and the Government was notified of this on 18 December and “immediately started to take action”: BBC One, ‘Professor Susan Hopkins on the new coronavirus variant’, accessed 17 August 2021. 210 GOV.UK, ‘Coronavirus (COVID-19) in the UK’, web archive, accessed 17 August 2021 Coronavirus: lessons learned to date 53 Threats Advisory Group (NERVTAG),211 gave a positive assessment of the timeliness of Government action on the new variant: “We sent our first note to them raising a significant concern on the 18th, and on the 19th measures were put in place.”.212 The Government moved to cancel most of the previously announced relaxations of restrictions at Christmas, and thereafter introducing a third national lockdown from 6 January 2021.213
Department for Science, Innovation and Technology
Department of Health and Social Care
The second wave of the pandemic was more numerous in terms of hospital admissions and...
Conclusion · source text
The second wave of the pandemic was more numerous in terms of hospital admissions and deaths than the first wave. It peaked on 8 January 2021 with 68,053 new infections per day reported in the UK,214 and on 20 January with 1,820 deaths.215 This wave was dominated by the Alpha variant. The Alpha variant was dominant at the time of the peak infections and deaths, and had represented over 50% of UK covid infections from 4 January 2021.216 Of the total deaths during second wave,217 56.9% took place after the Alpha variant was the dominant form.
Department for Science, Innovation and Technology
Department of Health and Social Care
Due to the much higher transmissibility of the Alpha variant, in the absence of a...
Conclusion · source text
Due to the much higher transmissibility of the Alpha variant, in the absence of a test, trace and isolate system capable of arresting the spread of the virus, a circuit-breaker in September and an earlier, more stringent lockdown, would likely have reduced deaths. Had more stringent social distancing measures been adopted during the autumn they could have reduced the seeding of the Alpha variant across the country, slowed its spread and therefore have saved lives. However, this is something we know now, but was not knowable at the time lockdown decisions were taken during the autumn: the existence of the Alpha variant was known only in December 2020.
Department for Science, Innovation and Technology
Department of Health and Social Care
But these decisions were taken before the existence of the Alpha variant was known.
Conclusion · source text
But these decisions were taken before the existence of the Alpha variant was known. So the justification for an earlier lockdown is greatly influenced by information that was not available at the time. It serves to illustrate that, in a pandemic whose course is unknown, some decisions will be taken which turn out to have been wrong, but which it was not possible to know at the time. Public health messaging and communication
Department for Science, Innovation and Technology
Department of Health and Social Care
Several public health experts stressed to us that an effective messaging and communications strategy was...
Conclusion · source text
Several public health experts stressed to us that an effective messaging and communications strategy was a crucial part of the response to a pandemic. In July 2020, Sir Paul Nurse argued in evidence to the Health and Social Care Committee that “communication, messaging and keeping trust” should be one of the core focuses of the Government’s strategy.218 This was echoed by Sir Jeremy Farrar, who explicitly linked consistent messaging to public compliance with other NPIs: 211 NERVTAG is an expert committee of the Department of Health and Social Care (DHSC), which advises the Chief Medical Officer (CMO) and, through the CMO, Ministers, DHSC and other Government departments. 212 Oral evidence taken before the Science and Technology Committee on 23 December 2020, HC (2019–21) 136, Q1612 213 GOV.UK, ‘Prime Minister’s statement on coronavirus (COVID-19): 19 December 2020’, and HC Deb, 6 January 2021, cols 734–736 [Commons Chamber] 214 GOV.UK, ‘Cases in the UK: Coronavirus in the UK—cases by date reported’, accessed 17 August 2021 215 GOV.UK, ‘Deaths in the UK: Coronavirus in the UK—Deaths within 28 days of positive test by date reported’, accessed 17 August 2021 216 Ourworldindata, SARS-CoV-2 variants in analyzed sequences, United Kingdom, accessed 2 September 2021 217 According to the Office for National Statistics, the second wave was estimated to be between 7 September 2020 to 24 April 2021. 218 Oral evidence taken before the Health and Social Care Committee on 21 July 2020, HC (2019–2021) 36, Q589 54 Coronavirus: lessons learned to date Consistent messaging and trust in the messaging is absolutely vital. If you are asking anybody—the community or the public—to do things that they would not normally do, they have to trust the message and the messenger, and that has to be consistent over time.219
Department for Science, Innovation and Technology
Department of Health and Social Care
At the outset of the pandemic, the Prime Minister’s “stay at home” order was accompanied...
Conclusion · source text
At the outset of the pandemic, the Prime Minister’s “stay at home” order was accompanied by a public messaging campaign that clearly instructed the public to “stay home, protect the NHS, save lives”. This message was driven by regular televised press conferences from Number 10 Downing Street, during which Ministers sought to emphasise that the response was “built upon the bedrock of the best possible scientific and medical advice”.220 Professor Whitty credited this initial messaging as “absolutely essential in people understanding what needed to happen, and then doing it.”221 The message was clear in both the instruction it was giving the public, as well as plainly explaining why they were being asked to change their behaviour.
Department for Science, Innovation and Technology
Department of Health and Social Care
Much of the evidence to our inquiry has acknowledged that this “Stay at Home” slogan...
Conclusion · source text
Much of the evidence to our inquiry has acknowledged that this “Stay at Home” slogan was successful in fostering sufficient levels of awareness and understanding among the public. For example, during this period there was a marked fall in the number of people travelling on the roads and using recreational areas. Written evidence from the Nuffield Trust attributed this apparent success to the “simplicity and ease of recall” of the message.222 According to Professor Devi Sridhar, Chair of Global Public Health at the University of Edinburgh, the public are more likely to comply with instructions that are clear and easy to understand: You have to take the public with you. The public will comply, not because they are forced to, or because there is military on the streets, but because they want to. People generally want to follow the rules if they understand them.223
Department for Science, Innovation and Technology
Department of Health and Social Care
Evidence from University College London (UCL) showed that during the first lockdown, the simplicity and...
Conclusion · source text
Evidence from University College London (UCL) showed that during the first lockdown, the simplicity and clarity of public health messaging did indeed translate into high levels of compliance with the stay at home order. According to UCL, during this period “levels of understanding were reported by individuals to be very high” and simultaneously “over 70% of [70,000] survey respondents reported ‘complete compliance’ with guidelines”.224
Department for Science, Innovation and Technology
Department of Health and Social Care
Although the communications strategy in the initial phase of the pandemic was broadly successful, it...
Conclusion · source text
Although the communications strategy in the initial phase of the pandemic was broadly successful, it is worth noting that there was some confusion over who the stay at home order applied to, and there was criticism of the Government’s decision not to provide a British Sign Language (BSL) interpreter on-set at the televised briefings. Similar briefings in Scotland and Wales did include an interpreter, socially distanced from Ministers. In the UK, there are more than 80,000 Deaf people whose first language is BSL.225 The decision not 219 Oral evidence taken before the Health and Social Care Committee on 21 July 2020, HC (2019–2021) 36, Q585 220 GOV.UK, Health and Social Care Secretary’s statement on coronavirus (COVID-19), 5 April 2020. 221 Q827 222 Nuffield Trust (CLL0087) 223 Oral evidence taken before the Health and Social Care Committee on 21 July 2020, HC (2019–2021) 36, Q584 224 University College London (CLL0023) 225 Equality and Human Rights Commission, Letter to the Prime Minister, April 2020. Coronavirus: lessons learned to date 55 to include an interpreter at these briefings, where important public health announcements were often made, may have reduced their ability to understand the messages provided and in turn potentially decreased trust and compliance among this group.
Department for Science, Innovation and Technology
Department of Health and Social Care
On 10 May 2020, the Government announced that society would begin to reopen in England...
Conclusion · source text
On 10 May 2020, the Government announced that society would begin to reopen in England through a staged series of lockdown easing measures.226 From this point, there were divergent approaches to messaging across the four nations of the UK. To reflect the gradual lifting of strict lockdown measures in England, the Government changed its slogan from “stay home, protect the NHS, save lives” to “stay alert, control the virus and save lives”.227 In contrast, during a press conference on the same day, the First Minister of Scotland emphasised that “we remain in lockdown for now and my ask of you remains to Stay at Home”.228
Department for Science, Innovation and Technology
Department of Health and Social Care
Written evidence to our inquiry suggested that the loss of consistency across the four nations...
Conclusion · source text
Written evidence to our inquiry suggested that the loss of consistency across the four nations led to confusion, with “messages from numerous national bodies that, at times, appeared to contradict each other”.229 We heard that at this stage, these contradicting messages began to cause confusion. Professor Devi Sridhar, speaking to the Health and Social Care Committee in July 2020, explicitly linked this confusion to infection rates: One point where you can see that England and Scotland diverged was when England changed in May to: “Stay alert.” Many people did not fully understand what that meant. In Scotland, the message was very clear: “Stay at home.” When we started to see divergence in infection rates and death rates, it was around that time.230
Department for Science, Innovation and Technology
Department of Health and Social Care
The three-tier approach to local lockdown restrictions in England (see paragraph 117) introduced more complexity...
Conclusion · source text
The three-tier approach to local lockdown restrictions in England (see paragraph 117) introduced more complexity to Government messaging which was, understandably different in different parts of the country.231 It was therefore unsurprising that this more differentiated messaging strategy meant that levels of public understanding and compliance began to deteriorate. Written evidence submitted by UCL showed much poorer comprehension of the rules than at the beginning of the pandemic. By October, fewer than half of the over 70,000 adults who took part in the survey reported broad understanding of the rules (45%), with just 14% understanding them ‘very much’. Self- reported compliance was consequently also much lower, with just over 40% reporting ‘complete compliance’ with guidelines, compared to 70% earlier in the pandemic.232
Department for Science, Innovation and Technology
Department of Health and Social Care
Written evidence suggested that the inconsistency in Government messaging after the first wave of the...
Conclusion · source text
Written evidence suggested that the inconsistency in Government messaging after the first wave of the pandemic was also damaging to public trust in official information.233 Analysis submitted by Leeds Beckett University showed that most members of the public did not trust information from the UK Government and that they were much more likely to trust information shared by the World Health Organisation.234 The perception that key Government figures, including the former assistant to the Prime Minister, had breached lockdown rules may have further undermined public trust during spring 2020. In oral 226 GOV.UK, ‘Prime Minister’s Statement on coronavirus (COVID-19): 10 May 2020’, accessed 17 September 2021 227 GOV.UK, ‘Prime Minister’s Statement on coronavirus (COVID-19): 10 May 2020’, accessed 17 September 2021 228 Gov.scot, ‘Coronavirus update: First Minister’s speech: 10 May 2020’, accessed 17 September 2021 229 Association of Anaesthetists (CLL0014) 230 Oral evidence taken before the Health and Social Care Committee on 21 July 2020, HC (2019–2021) 36, Q584 231 GOV.UK, ‘Prime Minister announces new local COVID Alert Levels: 12 October 2020’, accessed 17 September 2021 232 University College London (CLL0023) 233 For example, see: Nuffield Trust (CLL0087) 234 Leeds Beckett University (CLL0003) 56 Coronavirus: lessons learned to date evidence, Dominic Cummings acknowledged that his widely reported trip to Durham was “a complete disaster” and admitted that it “undermined public confidence in the whole thing”.235
Department for Science, Innovation and Technology
Department of Health and Social Care
Lower levels of public trust and understanding of the regulations also created a gap into...
Conclusion · source text
Lower levels of public trust and understanding of the regulations also created a gap into which misinformation was able to spread. Research conducted by Ofcom in the first six weeks of the pandemic found that 47% of respondents said they had come across false or misleading information about covid-19 in the last week. Most commonly, respondents indicated that the misinformation they encountered was linked to “theories linking the origins or causes of covid-19 to 5G technology”.236 More recently, a study conducted by King’s College London in November 2020 found that 14% of respondents “believe the real purpose of a mass vaccination programme against coronavirus is simply to track and control the population”.237 Susceptibility to covid-19 misinformation has many causes, but research has found that lower levels of trust in both scientists and Government are associated with increased susceptibility to misinformation.238 This highlights the critical importance of a communications strategy which is clear, consistent and perceived as transparent by the public. Outcomes
Department for Science, Innovation and Technology
Department of Health and Social Care
The covid pandemic is a global emergency that is not yet over.
Conclusion · source text
The covid pandemic is a global emergency that is not yet over. While the UK’s trajectory may have changed in recent months with vaccines, the vast majority of the world is still grappling with the disease. It would be prudent to reserve judgement on the UK’s performance until the pandemic is over across the world. When that time comes, we will be able to more accurately and fairly judge the UK’s performance against the rest of the world.
Department for Science, Innovation and Technology
Department of Health and Social Care
One of the key ways to measure a country’s success in fighting covid-19 is to...
Conclusion · source text
One of the key ways to measure a country’s success in fighting covid-19 is to measure deaths from covid-19. However, countries across the world measure deaths in different ways. The UK has reported covid deaths as those who died within 28 days of a positive test. The UK also offers statistics on daily deaths with covid-19 on the death certificate. The US Centres for Disease Control includes both confirmed and probable cases and deaths.239 The historian, Professor Niall Ferguson, told the House of Commons Foreign Affairs Committee: I actually think there is a better way of looking at this, which is to look at excess mortality. We don’t have excess mortality data for all the countries in the world, but if you look at the ones for which we do have data, the UK and the US are firmly in the middle of the table, with 17% or 18% excess mortality, close to Belgium, close to Italy, close to Spain. 235 Q1115 236 Ofcom, ‘covid-19 news and information: consumption and attitudes- previous results’, accessed 17 September 2021 237 Kings College London, Coronavirus: vaccine misinformation and the role of social media, December 2020 238 See, for example: The Royal Society, Susceptibility to misinformation about COVID-19 around the world, October 2020; The Royal Society, COVID-19 vaccine deployment: Behaviour, ethics, misinformation and policy strategies, October 2020 239 CDC, ‘United States COVID-19 Cases and Deaths by State over Time’, accessed 17 September 2021 Coronavirus: lessons learned to date 57 Some countries in Europe did slightly better—France, Sweden, Switzerland— but there are a great many countries that did a good deal worse. I won’t recap the countries you are expecting to hear—once again, it is Latin American and east European countries that have the worst excess mortality. Of course, some countries in Europe have done significantly better, to the point, in the case of Denmark, of having no excess mortality, or virtually none in Norway. I think this is probably the be
Department for Science, Innovation and Technology
Department of Health and Social Care
There are also other factors to be considered.
Conclusion · source text
There are also other factors to be considered. Each country has a unique set of characteristics which might have contributed to its health related covid-19 outcomes. For example, the UK has the tenth-highest rate of obesity in the world,241 which is linked to an increased risk of adverse outcomes.242 Conclusions and recommendations Conclusions
Department for Science, Innovation and Technology
Department of Health and Social Care
During the first three months of the covid pandemic, the UK followed the wrong policy...
Conclusion · source text
During the first three months of the covid pandemic, the UK followed the wrong policy in its use of non-pharmaceutical interventions. When the UK moved from the ‘contain’ to ‘delay’ stage, there was a policy of seeking to only moderate the speed of infection through the population—flattening the curve—rather than seeking to arrest its spread. The policy was pursued until 23 March because of the official scientific advice the Government received, not in spite of it. Questions remain about whether the containment phase was pursued aggressively enough—we believe it could have been pursued for longer. During this period Government policy did not deviate from the scientific advice it received in any material respect. The fact that the UK approach reflected a consensus between official scientific advisers and the Government indicates a degree of groupthink that was present at the time which meant we were not as open to approaches being taken elsewhere—such as earlier lockdowns, border controls and effective test and trace—as we should have been.
Department for Science, Innovation and Technology
Department of Health and Social Care
The flattening the curve policy was implemented by introducing new restrictions only gradually and slowly,...
Conclusion · source text
The flattening the curve policy was implemented by introducing new restrictions only gradually and slowly, acting as if the spread of the virus were susceptible to calibrated control. Modelling at the time suggested that to suppress the spread of covid-19 too firmly would cause a resurgence when restrictions were lifted. This was thought likely to result in a peak in the autumn and winter when NHS pressures were already likely to be severe. In addition, it was thought that the public would only comply with severe restrictions for a limited period, and so those restrictions should not be applied before they were most needed. This approach should have been questioned at the time for a number of reasons: 240 Oral evidence taken before the Foreign Affairs Select Committee on 22 June 2021, HC (2021–22) 200, Q134 241 OECD, Obesity Update, 2017 242 GOV.UK, Disparities in the risk and outcomes of COVID-19, August 2020 58 Coronavirus: lessons learned to date • it entailed people contracting covid in large numbers with hundreds of thousands of deaths likely to result; • other countries, in Asia and in Europe, including some with experience of SARS and MERS, had chosen to implement earlier, more comprehensive strategies of non-pharmaceutical interventions, which were having success; and • suppressing the spread of the virus in the early period would have bought valuable time to consider what was the best way to manage the pandemic in the medium term.
Department for Science, Innovation and Technology
Department of Health and Social Care
There are several possible explanations for what was a significant error in policy and advice...
Conclusion · source text
There are several possible explanations for what was a significant error in policy and advice early in the pandemic. These include: • the lack of adequate data on the spread of covid-19, as a result of the inadequacy of the UK testing operation; • overreliance on specific mathematical models when there were too many uncertainties; • assumptions about public compliance with rules that turned out to have underestimated the willingness to conform even for long periods; • the composition of SAGE suffered from a lack of representation from outside the United Kingdom; and • a preference for a particular UK approach may have been favoured above advice based on emulation of what was being pursued elsewhere.
Department for Science, Innovation and Technology
Department of Health and Social Care
Science proceeds through challenge and disputation, and new theories are tested unflinchingly against evidence.
Conclusion · source text
Science proceeds through challenge and disputation, and new theories are tested unflinchingly against evidence. Yet Ministers and other advisers reported that they felt it difficult to challenge the views of their official scientific advisers. Those in Government have a duty to question and probe the assumptions behind any scientific advice given, particularly in a national emergency, but there is little evidence sufficient challenge took place. However, even when UK policy had changed to bring in a comprehensive national lockdown, the role of non-pharmaceutical interventions against covid-19 was complex, inconsistent and opaque for most of the rest of 2020.
Department for Science, Innovation and Technology
Department of Health and Social Care
The second wave of covid infections, hospitalisations and deaths during the autumn and winter of...
Conclusion · source text
The second wave of covid infections, hospitalisations and deaths during the autumn and winter of 2020/21 was significantly driven by the emergence of a new variant, known as the Kent or Alpha variant. It is likely that a “circuit break” of temporary lockdown measures if introduced in September 2020, and earlier lockdown measures during the winter, could have impeded the rapid seeding and spread of the Kent variant. However, the existence of the Kent or Alpha variant was not known by the Government until 11 December 2020 so that the justification for taking earlier measures could not rely on information available at the time.
Department for Science, Innovation and Technology
Department of Health and Social Care
Government public health communications are key to the public’s understanding of and compliance with non-pharmaceutical...
Conclusion · source text
Government public health communications are key to the public’s understanding of and compliance with non-pharmaceutical interventions. Initial messaging from the Government early in the pandemic was strong, effective and undoubtedly contributed to the success of the first lockdown. After the gradual lifting of the first lockdown Coronavirus: lessons learned to date 59 from May 2020, Government guidance became increasingly complex and harder to understand, with restrictions varying in different parts of the country. Government communications did not always reflect this nuance, leading to perceived inconsistency and divergent strategies across the four nations of the UK. Recommendations and lessons learned
Department for Science, Innovation and Technology
Department of Health and Social Care
In the early days of a crisis, scientific advice may be necessarily uncertain: data may...
Conclusion · source text
In the early days of a crisis, scientific advice may be necessarily uncertain: data may be unavailable, knowledge limited and time may be required for analysis to be conducted. In these circumstances it may be appropriate to act quickly, on a precautionary basis, rather than wait for more scientific certainty.
Department for Science, Innovation and Technology
Department of Health and Social Care
In future an approach of greater questioning and challenge should characterise the development of policy.
Recommendation · source text
In future an approach of greater questioning and challenge should characterise the development of policy. Ministers should have the confidence to follow a scientific approach themselves—being prepared to take a more robust approach to questioning and challenging the advice given. The Government and SAGE should also facilitate strong external and structured challenge to scientific advice, including from experts in countries around the world, and a wider range of disciplines.
Department for Science, Innovation and Technology
Department of Health and Social Care
In bringing together many of the UK’s most accomplished scientists, SAGE became a very UK...
Recommendation · source text
In bringing together many of the UK’s most accomplished scientists, SAGE became a very UK body. In future, it should include more representation and a wider range of disciplines, from other countries, especially those which have experienced, or are experiencing, the same emergency.
Government response · verbatim
The government partially accepts this recommendation. The government engages with other nations and international experts through a range of fora, such as the G7, the G20, and via WHO. With respect to the provision of scientific advice, much engagement with international experts occurred from the outset of the pandemic, and this is an important principle to keep for future emergencies. SAGE has drawn international perspectives from SAGE participants' wider international academic networks. Science is an international endeavour and most if not all of the contributing national academies are in collaboration, or at least discussions, with international counterparts. Effective international collaboration and responsive coordination between national public health institutes (NPHIs), or equivalent public health bodies, is also crucial for sharing data, evidence, and research as the COVID-19 pandemic progresses, as well as for learning from each other. A strong network of NPHIs is needed to strengthen existing networks of Emergency Operation Centres and to build laboratory network capability. Public Health England (PHE) and UKHSA’s active membership in the International Association of National Public Health Institutes (IANPHI), comprising 110 members in 95 countries, has been essential for the exchange of information and joint actions. It has also drawn on the network to learn from other countries in their response to the COVID-19 pandemic and continues to do so. In addition, through bilateral engagement, DHSC collaborates internationally to exchange knowledge with other countries on matters such as effective future pandemic preparedness. The Department will continue to engage bilaterally with countries from around the world to learn from the breadth of global activity on prevention and detection of infectious diseases, and inform UK thinking where lessons could be learned. This has been reinforced through engagement in the margins of G7 and G20 Health Ministers’ meetings (specifically with the United States, India, Germany, Italy, Singapore, Argentina, Netherlands, Brazil, and Saudi Arabia), as well as through the World Health Assembly and other multilateral fora. The Department will continue to take advantage of bilateral opportunities to learn from international experience and share the UK’s expertise, to improve future pandemic preparedness. It is vital that the work to prepare for the next pandemic is a collaborative global effort by governments, international organisations, and industry partners. The Pandemic Preparedness Partnership’s ‘100 Days Mission’ report,8 which was welcomed by G7 leaders, includes recommendations to guide governments, international organisations, and industry partners on steps which can be taken now and over the longer-term to ensure the mission is achieved. The UK government will work with other nations across the globe to implement these recommendations.
Read full response →
Department for Science, Innovation and Technology
Department of Health and Social Care
In a pandemic, the scientific advice from the SAGE co-chairs to the Government should be...
Recommendation · source text
In a pandemic, the scientific advice from the SAGE co-chairs to the Government should be published within 24 hours of it being given, or the policy being decided, whichever is the later, to ensure the opportunity for rapid scientific challenge and guard against the risk of ‘groupthink’. In addition, minutes and SAGE papers should be published within 48 hours of the meeting taking place.
Department for Science, Innovation and Technology
Department of Health and Social Care
The Government, via the World Health Organisation, should make the case for an international standard...
Recommendation · source text
The Government, via the World Health Organisation, should make the case for an international standard of reporting covid-19 deaths and a framework for reporting disease related deaths for future pandemics. 60 Coronavirus: lessons learned to date 4 Testing and contact tracing
Department for Science, Innovation and Technology
Department of Health and Social Care
While, as we will illustrate in Chapter 7, the UK’s vaccination programme has been a...
Conclusion · source text
While, as we will illustrate in Chapter 7, the UK’s vaccination programme has been a national success, the record during the pandemic of the test, trace and isolate programme is more mixed. The slow, uncertain, and often chaotic performance of the test, trace and isolate system during the first phases of the pandemic was a drag anchor on the UK’s response to the pandemic. Partly because NHS Test and Trace was only established when daily infections had risen to 2,000, it ultimately failed in its objective to prevent future lockdowns despite vast quantities of taxpayers’ money being directed to it.243 In contrast to the approach to vaccines, which we discuss in greater detail in Chapter 7, NHS Test and Trace had to build a new organisation and respond to changing circumstances while it was operating rather than being able to anticipate these in advance of the system being in operation. In this Chapter, when we refer to NHS Test and Trace we refer to the new organisation set up by the Department of Health and Social Care, initially led by Baroness Harding, in partnership with several public and private organisations.
Department for Science, Innovation and Technology
Department of Health and Social Care
This Chapter looks at a number of different facets of the test, trace and isolate...
Conclusion · source text
This Chapter looks at a number of different facets of the test, trace and isolate system— though they are illustrative rather than exhaustive. While it describes an unsatisfactory history, there are signs that the UK has now arrived at a more dependable outcome: the UK now has, in principle, the ability to test more than 800,000 people a day, and in the week commencing 23 August 2021 there were more than 5.6 million tests carried out in England, more than any EU/EEA country.244 But there are many lessons to be learned on the way and this notional capacity has yet to be fully tested in action.
Department for Science, Innovation and Technology
Department of Health and Social Care
In this Chapter we consider in particular: • the initial testing capacity available; • the...
Conclusion · source text
In this Chapter we consider in particular: • the initial testing capacity available; • the decision to abandon testing in the community; • the 100,000 tests a day target introduced by the then Secretary of State; • the centralisation of testing laboratories; • the shortage of testing capacity in Autumn 2020; • the organisation of contact tracing; and • the management of “NHS” Test and Trace. Limited testing capacity
Department for Science, Innovation and Technology
Department of Health and Social Care
During the early days of the pandemic, the Government believed—and told the public—that testing for...
Conclusion · source text
During the early days of the pandemic, the Government believed—and told the public—that testing for covid-19 was a field in which the UK had a leading position. This assessment was shared, and possibly arose out of, the views of scientific advisers. The minutes of the very first SAGE meeting on covid-19 on 22 January 2020 stated: 243 On 2 April 2020, when the Government announced its new 5-pillar testing strategy, 4,522 Covid-19 cases were recorded. 244 GOV.UK, ‘Coronavirus in the UK: Testing’; European Centre for Disease Prevention and Control, ‘Data on testing for COVID-19 by week and country’. Coronavirus: lessons learned to date 61 The UK currently has good centralised diagnostic capacity for WN-CoV [covid-19]–and is days away from a specific test, which is scalable across the UK in weeks.245 The following day, on 23 January 2020, the then Secretary of State for Health and Social Care told the House that the UK is “one of the first countries to have developed a world-leading test for the new coronavirus.”246 When the Prime Minister claimed to have “growing confidence that we will have a test, track and trace operation that will be world-beating,” it may be that this early lead was what he had in mind.247 However, it rapidly became apparent that the scientific expertise in identifying the virus and the ability to deploy that operationally were very different. Public Health England was initially responsible for managing covid-19 testing as well as the scientific development of a test for covid-19, but it is in the former that its deficiencies were exposed.
Department for Science, Innovation and Technology
Department of Health and Social Care
SAGE minutes from 28 January 2020 recorded that notwithstanding the scientific lead in establishing a...
Conclusion · source text
SAGE minutes from 28 January 2020 recorded that notwithstanding the scientific lead in establishing a test, PHE only had operational capacity to administer “400 to 500 tests per day” for the whole country.248 Other countries such as South Korea and Hong Kong, who did not benefit from our lead in producing a test, nevertheless rapidly developed a testing capacity to allow a comprehensive testing programme to be put in place during the early weeks of the pandemic.249 By contrast, during the whole, crucial, period between 25 January and 11 March 2020, in which the virus was spreading across the whole country, only 27,476 coronavirus tests were performed in the UK.250 To put this in context, that is less than one test a day for each parliamentary constituency.
Department for Science, Innovation and Technology
Department of Health and Social Care
Professor Martin explained to us that early in the pandemic there were “very severe constraints...
Conclusion · source text
Professor Martin explained to us that early in the pandemic there were “very severe constraints in equipment and consumables” which acted as a drag on testing capacity: Bear in mind that those were all new tests coming on stream at the beginning of the pandemic. Effectively, there was not enough to go round. It was global; it was not just the UK. There was a global shortage of the consumables. […] There are big international suppliers that have capped the UK supply of consumables251
Department for Science, Innovation and Technology
Department of Health and Social Care
However, throughout the pandemic, our Committees have taken a great interest in what might be...
Conclusion · source text
However, throughout the pandemic, our Committees have taken a great interest in what might be learned and applied from how other countries tackled the virus. In March 2020, the World Health Organisation recommended that nations “plan for surge capacity by establishing decentralized testing capacity in sub-national laboratories”.252 Dr Seon Kui Erica Lee, of the Korea Centers for Disease Control and Prevention, told the Science and Technology Committee in April 2020 that testing capacity in the Republic of Korea had expanded rapidly because of lessons learned from the 2015 MERS outbreak.253 Dr 245 GOV.UK, SAGE 1, 22 January 2020 246 HC oral statement, 23 January 2020, Vol 670 [Commons Chamber] 247 HC oral questions, 20 May 2020, Vol 676 [Commons Chamber] 248 GOV.UK, SAGE 2, 28 January 2020 249 See, for example: oral evidence taken before the Health and Social Care Committee on 19 May 2020, HC (2019– 21) 36 and oral evidence taken before the Science and Technology Committee on 16 April 2020, HC (2019–21) 136 250 Department of Health and Social Care, via Twitter, 11 March 2020 251 Q343 252 World Health Organisation, ‘Laboratory testing strategy recommendations for COVID-19: interim guidance: 23 March 2020’, accessed 17 September 2021 253 Oral evidence taken before the Science and Technology Committee on 8 April 2020, HC (2019–21) 136, Q145 62 Coronavirus: lessons learned to date Max Roser also explained to us that “by mid-March [2020], Germany was testing 50,000 people per day”, whilst the UK was “very late” and reached the same capacity one and a half months later.254
Department for Science, Innovation and Technology
Department of Health and Social Care
In evidence to the Science and Technology Committee on 25 March 2020 Public Health England...
Conclusion · source text
In evidence to the Science and Technology Committee on 25 March 2020 Public Health England claimed to have formally studied, but rejected, the South Korean approach.255 Despite repeated requests by the Committee no evidence of such an evaluation has ever been produced. We must conclude that no formal evaluation took place which amounts to an extraordinary and negligent omission given Korea’s success in containing the pandemic which was well-publicised at the time.
Department for Science, Innovation and Technology
Department of Health and Social Care
As a result the UK squandered a leading position in diagnostics and converted it into...
Conclusion · source text
As a result the UK squandered a leading position in diagnostics and converted it into one of permanent crisis. On 12 March, testing for covid-19 other than in hospitals was halted. In part this was because of the inadequacy of the early flu-based strategy—a flu-strategy which mandated ending testing when there was community transmission— but partly also because of a simple lack of capacity. The abandonment of community testing meant that contact tracing—which was fundamental to the success of the Korean approach—also had to be abandoned. If people could not be tested, their contacts could not be traced.
Department for Science, Innovation and Technology
Department of Health and Social Care
Shortly after this seminal failure, in mid-March 2020 responsibility for the testing strategy was taken...
Conclusion · source text
Shortly after this seminal failure, in mid-March 2020 responsibility for the testing strategy was taken over by the Department of Health and Social Care from Public Health England.256 It was not until 18 May 2020, when the first wave of covid-19 had begun to wane in the UK, that widespread community testing for covid-19—and therefore contact tracing—was able to resume.257
Department for Science, Innovation and Technology
Department of Health and Social Care
The consequences of this initial failure were profound.
Conclusion · source text
The consequences of this initial failure were profound. Testing not only allowed individuals to be identified who had covid-19—and were infectious—but test results for an invisible virus were the only way to be able to accurately monitor the incidence and spread of the virus across the country, and to understand which groups it affected most and which it affected least.258 The UK was reduced to understanding the spread of covid-19 by waiting for people to be so sick that they needed to be admitted to hospital.
Department for Science, Innovation and Technology
Department of Health and Social Care
For a country with a world-class expertise in data analysis, to face the biggest health...
Conclusion · source text
For a country with a world-class expertise in data analysis, to face the biggest health crisis in a hundred years with virtually no data to analyse was an almost unimaginable setback. The reasons for this initial inadequacy to translate testing technology into deployable testing capacity are varied. Public Health England seemed to be better at its scientific responsibilities than in its operational response to a mass outbreak of disease and was not clearly instructed to rectify the issue.259 Public Health England reported directly to the Department of Health and Social Care, with only limited operational independence, so the Department too should have been more aware of the issue.
Department for Science, Innovation and Technology
Department of Health and Social Care
We also consider that the Government’s scientific advisers were too passive in accepting assurances that...
Conclusion · source text
We also consider that the Government’s scientific advisers were too passive in accepting assurances that the clinical operational capacity of Public Health England could not be changed. Even in March 2020, Professor Neil Ferguson explained that “much 254 Q129 255 Oral evidence taken before the Science and Technology Committee on 25 March 2020, HC (2019–21) 136, Q121 256 Oral evidence taken before the Science and Technology Committee on 21 July 2020, HC (2019–21) 136, Q1176 257 GOV.UK, ‘Everyone in the UK with symptoms now eligible for coronavirus tests’, accessed 17 September 2021 258 Oral evidence taken before the Health and Social Care Committee on 17 March 2020, HC (2019–21) 36, Q78 259 See, for example: Q825, Q1256, Q1264 and Q1280 Coronavirus: lessons learned to date 63 more widespread testing” was required but that SAGE had received “very clear messages from PHE that we would have nowhere near enough testing capacity.”260 It would have been quite possible for SAGE to advise that a significant increase in testing capacity was needed. It may be that continued adherence to the early four-stage flu plan contributed to this absence of effective scientific pressure for more testing capacity.
Department for Science, Innovation and Technology
Department of Health and Social Care
It is clear that there should have been more challenge to Public Health England to...
Conclusion · source text
It is clear that there should have been more challenge to Public Health England to increase testing capacity from the outset by Ministers, scientific advisers and the Department of Health and Social Care rather than accepting it as a fait accompli. Consequences of abandoning testing in the community
Department for Science, Innovation and Technology
Department of Health and Social Care
As noted earlier, the failure to have enough testing capacity in the early weeks of...
Conclusion · source text
As noted earlier, the failure to have enough testing capacity in the early weeks of the pandemic contributed to a lack of knowledge as to how the infection was spreading in the country. Speaking to us in November 2020, Professor Sir Chris Ham, Chair of the Coventry and Warwickshire Sustainability and Transformation Partnership, reflected that the decision to halt test and trace in the community had been a practical decision, and that any scientific advice behind it had “not been forthcoming”: if you go back to March, we simply did not have the capacity for testing, tracing and isolating that we needed in relation to the volume of cases. […] Testing capacity had to be focused on the high priorities—staff working in health and care and patients receiving that care. It was very sad that that decision had to be taken, but it was not about science. It was about practicalities.261
Department for Science, Innovation and Technology
Department of Health and Social Care
The lack of data resulting from suspending community testing also affected the UK’s understanding of...
Conclusion · source text
The lack of data resulting from suspending community testing also affected the UK’s understanding of the disease at that critical time. Professor Neil Ferguson explained to the Science and Technology Committee in June 2020 that low testing capacity meant it was difficult to estimate the proportion of imported cases which had been missed: at the time we had a policy of trying to screen people at borders, and we estimated then that maybe two thirds of imported cases had been missed. What we now know, because the epidemic took off in Italy and Spain before anybody had realised, is that probably 90% of cases imported into this country were missed by those border measures, because we were not checking people. […] Had we had the testing capacity […] screening everybody with symptoms coming in would have given us a much better impression of where infection was coming from.262 260 Oral evidence taken before the Science and Technology Committee on 25 March 2020, HC (2019–21) 136, Q20 261 Q319 and Q323 262 Oral evidence taken before the Science and Technology Committee on 10 June 2020, HC (2019–21) 136, Q870, Q873 64 Coronavirus: lessons learned to date Arguably this lack of data could have contributed to the delay in the critical decision to instigate a nationwide lockdown. As Professor Chris Whitty explained: because we had very limited testing capacity, we did not realise quite how far along the curve we were, because we were having to use people in intensive care and who had sadly died, which is quite a late event. If we had the capacity on testing then that we have now, we would have come to very different conclusions using exactly the same science.263 Professor Whitty suggested that one key lesson was to “build our capacity to do testing […] at scale”, which he described would be “a problem with any pandemic we have in the future”.264 Impact on health and social care
Department for Science, Innovation and Technology
Department of Health and Social Care
Professor Chris Whitty told the Health and Social Care Committee in July 2020 that the...
Conclusion · source text
Professor Chris Whitty told the Health and Social Care Committee in July 2020 that the lack of testing capacity available at the beginning of the pandemic meant that the Government had to focus resources very closely on the hospital sector, and in particular intensive care units.265 Within hospitals, the prioritisation of patients admitted to intensive care meant less testing capacity was available for other patients in hospital, inhibiting the safe provision of non-covid NHS care and increasing the risk of nosocomial infections. The British Infection Association, the professional association for infection specialists, stated that “decisions about who to test and when early in the pandemic almost certainly led to […] nosocomial and [healthcare worker] infections in secondary care.”266 In February, a paper submitted to SAGE by Public Health England and the London School of Hygiene and Tropical Medicine estimated that during the first wave of covid-19 alone, 36,152 people in England contracted covid-19 while in hospital, representing 40.5% of all hospital cases.267
Department for Science, Innovation and Technology
Department of Health and Social Care
The lack of available testing for social care was particularly damaging, as we discuss in...
Conclusion · source text
The lack of available testing for social care was particularly damaging, as we discuss in more detail later in this Report. Crucially, it was not until mid-April that covid-19 testing was made a requirement for people discharged from hospital to social care—even on 2 April 2020 guidance still stated that negative tests were not required for a discharge to social care.268
Department for Science, Innovation and Technology
Department of Health and Social Care
The Health and Social Care Committee’s Reports on social care and the delivery of core...
Conclusion · source text
The Health and Social Care Committee’s Reports on social care and the delivery of core NHS and care services during the pandemic also highlighted the impact of a lack of testing for social care staff in the initial wave of the pandemic. Evidence from across the sector, including from staff themselves, was unanimous that the lack of provision of regular testing for social care staff had meant that social care staff were more likely to transmit the disease within care homes.269 263 Q825 264 Q825 265 Oral evidence taken before the Health and Social Care Committee on 21 July 2020, HC (2019–21) 36, Q620 266 British Infection Association (CLL0079)) 267 Public Health England, London School of Hygiene & Tropical Medicine, The contribution of nosocomial infections to the first wave, 28 January 2021. 268 See paragraphs 263–267. 269 Health and Social Care Committee, Third Report of Session 2019–21, Social care: funding and workforce, HC 206, paras 44, 45; Health and Social Care Committee, Second Report of Session 2019–21, Delivering core NHS and care services during the pandemic and beyond, HC 320, Paras 91, 92 Coronavirus: lessons learned to date 65 100,000 tests a day target introduced by Secretary of State
Department for Science, Innovation and Technology
Department of Health and Social Care
Following the initial shortage of testing capacity and the slow increase in the availability of...
Conclusion · source text
Following the initial shortage of testing capacity and the slow increase in the availability of tests during the critical first eight weeks of the pandemic, responsibility for the testing strategy was removed from Public Health England and vested in the Department of Health and Social Care. On 2 April the then Secretary of State announced a target of carrying out 100,000 covid tests a day by the end of the month.270 This was a personal initiative on the part of the then Secretary of State, Matt Hancock MP, to jump start substantial testing capacity. At the time witnesses to the Committees distanced themselves from the 100,000 target. For example, even the then Government testing tsar, Professor John Newton, said to the Science and Technology Committee “It is not a SAGE target; it is the Secretary of State’s target […] you would have to ask the Secretary of State himself exactly where he got his advice from.”271
Department for Science, Innovation and Technology
Department of Health and Social Care
Subsequently, Dominic Cummings, in evidence to our inquiry, strongly criticised the then Secretary of State...
Conclusion · source text
Subsequently, Dominic Cummings, in evidence to our inquiry, strongly criticised the then Secretary of State for naming this target, describing it as “an incredibly stupid thing to do.”272 However, Mr Hancock defended the target, saying to the Committees, “that 100,000 target was essential in galvanising the whole system and building a diagnostics organisation and ecosystem in this country.”273 The 100,000 target was announced as having been achieved by 30 April, although to do so required including tests which had been distributed by mail but which had not been processed.
Department for Science, Innovation and Technology
Department of Health and Social Care
Given the painfully slow increase in the availability of testing before April 2020, we consider...
Conclusion · source text
Given the painfully slow increase in the availability of testing before April 2020, we consider that the impact of the Secretary of State’s target to have been an appropriate one to galvanise the rapid change the system needed. However, as such a personal and unilateral approach was needed—and appears not to have been supported by other parts of Government—it is concerning to contemplate what would have happened without this unorthodox initiative.
Department for Science, Innovation and Technology
Department of Health and Social Care
As a result of the increase in testing capacity driven during April, the UK Government...
Conclusion · source text
As a result of the increase in testing capacity driven during April, the UK Government finally resumed community testing on 18 May 2020, following an expansion of capacity, which included more than a doubling of the NHS and PHE laboratory network capacity.274 In its April 2020 testing strategy, the Department of Health and Social Care set out a “five pillar” plan for how covid-19 testing would be scaled up: • Pillar 1: Scaling up NHS swab testing for those with a medical need and, where possible, the most critical key workers; • Pillar 2: Mass-swab testing for critical key workers in the NHS, social care and other sectors; • Pillar 3: Mass-antibody testing to help determine if people have immunity to coronavirus; 270 GOV.UK, ‘Health and Social Care Secretary’s statement on coronavirus: 2 April 2020’, accessed 17 September 2021 271 Oral evidence taken before the Science and Technology Committee on 8 April 2020, HC (2019–21) 136, Q176 272 Q1062 273 Q1264 274 GOV.UK, ‘Everyone in the United Kingdom with symptoms now eligible for coronavirus tests: 18 May 2020’, accessed 17 September 2021 66 Coronavirus: lessons learned to date • Pillar 4: Surveillance testing to learn more about the disease and help develop new tests and treatments; and • Pillar 5: Spearheading a Diagnostics National Effort to build a mass-testing capacity at a completely new scale.275 The capacity for community testing was expanded further primarily under ‘Pillar 2’ of the Government’s testing strategy, through the creation of a series of Lighthouse Lab facilities from early April onwards.276 These “mega-labs” were set up through partnerships between academia, commercial partners, public bodies and not-for-profit organisations, and integrated into a “new national testing infrastructure” and served the entire United Kingdom.
Department for Science, Innovation and Technology
Department of Health and Social Care
Evidence received by the Science and Technology Committee suggested that taking a centralised approach to...
Conclusion · source text
Evidence received by the Science and Technology Committee suggested that taking a centralised approach to increasing testing capacity was appropriate as it might not have been practical to focus on boosting local-level capacity alone. For example, Dr Richard Harling, Director of Health and Care for Staffordshire County Council, suggested that the expansion of testing capacity was “unlikely to be something we would have the expertise or specialism to do locally”.277 Similarly, Greg Fell, Director of Public Health at Sheffield City Council, suggested that while Sheffield was “very early in large-scale testing […] we quickly got to a stage where we needed the large-scale labs that we now have”.278
Department for Science, Innovation and Technology
Department of Health and Social Care
However, both our Committees heard that other resources could have been used more effectively in...
Conclusion · source text
However, both our Committees heard that other resources could have been used more effectively in the initial expansion of testing capacity. Professor Sir Chris Ham explained that initially the Government was “very much focused on building capacity in the commercial Lighthouse laboratories” but suggested that this focus was to the detriment of other potential capacity: if more had been done during the summer months […] for example, we could have made greater use of university laboratories and NHS laboratories—we might have been able to add capacity to avoid the bottlenecks that occurred [in September].279 Sir Paul Nurse also made this point, referring to an earlier press release by the Francis Crick Institute, stating: We argued very early on, in March it has to be said, that we should mobilise much more locally. We turned the Crick into a testing facility. We used that terrible metaphor of Dunkirk and little ships, and so on, but we produced a testing facility locally within two weeks that was doing 2,000 tests a day.280 275 Department of Health and Social Care, Coronavirus (COVID-19)—Scaling up our testing programmes, 4 April 2020 276 GOV.UK, ‘Health Secretary launches biggest diagnostic lab network in British history to test for coronavirus: 9 April 2020’, accessed 17 September 2021 277 Oral evidence taken before the Science and Technology Committee on 27 January 2021. HC (2019–21) 136, Q1812 278 Oral evidence taken before the Science and Technology Committee on 27 January 2021. HC (2019–21) 136, Q1812 279 Q338 280 Oral evidence taken before the Health and Social Care Committee on 21 July 2020, HC (19–21) 36, Q589; Francis Crick Institute, Francis Crick Institute and UCLH develop COVID-19 testing service for patients and NHS staff, 2 April 2020 Coronavirus: lessons learned to date 67 Professor Jo Martin, President of the Royal College of Pathologists, suggested that it was not strategically wrong to set up the Lighthouse Laboratory network to process testing on a
Department for Science, Innovation and Technology
Department of Health and Social Care
Despite this, it appeared that there was a disconnect between the testing operation in the...
Conclusion · source text
Despite this, it appeared that there was a disconnect between the testing operation in the Lighthouse Laboratories and NHS labs. For example, the Institute of Biomedical Science suggested that there was a “lack of integration and collaboration” between the laboratories providing Pillar 1 testing (NHS and PHE labs) and Pillar 2 testing (e.g. Lighthouse Labs).282 Further, Professor Martin told us that there should have been “more awareness of the end- to-end process”, pointing to one example of mismatched data systems.283 “World-beating” systems and moonshots
Department for Science, Innovation and Technology
Department of Health and Social Care
Throughout the last 18 months, the test and trace system has had labels applied that...
Conclusion · source text
Throughout the last 18 months, the test and trace system has had labels applied that have been at variance with the reality. Ministers began by promising the test and trace system would be “world-beating” in May 2020 when the truth was that it was that it was a laggard.284 Antibody tests were heralded in March 2020 by Ministers as “game changers” long before their role in the system was certain.285 In September 2020, the Prime Minister announced a new “moonshot” plan with the ambition to use rapid covid-19 tests with millions of tests processed daily which would allow normal lives to be resumed without the need for social distancing.286
Department for Science, Innovation and Technology
Department of Health and Social Care
In May 2020 the label “NHS” was applied by the Department of Health and Social...
Conclusion · source text
In May 2020 the label “NHS” was applied by the Department of Health and Social Care to the test and tracing system, despite it being operated outside the NHS. It was notable that in evidence to our inquiry, the then Chief Executive of NHS England, Sir Simon Stevens, pointedly refused to use the term NHS in conjunction with the Test and Trace operation.287 Mass testing ‘moonshot’
Department for Science, Innovation and Technology
Department of Health and Social Care
The Government has pursued both mass antibody testing (to identify who previously had covid-19) and...
Conclusion · source text
The Government has pursued both mass antibody testing (to identify who previously had covid-19) and mass diagnostic testing (to identify those currently infected) as means to return to normality. In its April 2020 testing strategy, the Government said it was “committed to mass testing” and stated its “overall ambition is to provide enough swab tests for everyone that needs one”.288 On 9 September 2020, the Prime Minister announced the Government’s “moonshot” plan with the ambition to use rapid covid-19 tests “on a far bigger scale than any country has yet achieved–literally millions of tests processed every 281 Qq343–344 282 Institute of Biomedical Science (CLL0083) 283 Q344 284 HC oral questions, 20 May 2020, Vol 676 [Commons Chamber] 285 UK Prime Minister Facebook, ‘PM Boris Johnson holds the daily press conference: 18 March 2020’, accessed 17 September 2021 286 GOV.UK, ‘Prime Minister’s statement on coronavirus (COVID-19): 9 September 2020’, accessed 17 September 2021 287 Q920 288 Department of Health and Social Care, Coronavirus: Scaling up our testing programmes, 4 April 2020 68 Coronavirus: lessons learned to date single day”.289 He also stated that this plan would “allow people to lead more normal lives, without the need for social distancing”. The Prime Minister expressed hope that by Christmas 2020, venues such as theatres could benefit from mass-scale rapid testing and that the technology would be “widespread by the spring”.290
Department for Science, Innovation and Technology
Department of Health and Social Care
That optimism does not appear to have been shared by scientists advising the Government, who...
Conclusion · source text
That optimism does not appear to have been shared by scientists advising the Government, who struck a more cautious note. For example, at the same press conference Sir Patrick Vallance pointed out that the technologies still had to be trialled, saying that it was “completely wrong to assume this is a slam dunk that can definitely happen”.291 Further, a SAGE ‘task and finish group’ on mass testing concluded in late August 2020 that the use of testing as a “point-of-entry requirement” for venues and events could reduce transmission risk but it would have a “minimal effect” on reducing ‘R’.292 Following trials in different settings, most notably a citywide trial in Liverpool,293 it was not until 9 April 2021 that rapid coronavirus testing was offered to everyone in England, including those without symptoms.294
Department for Science, Innovation and Technology
Department of Health and Social Care
As with other aspects of covid-19 testing, the Government has put a significant amount of...
Conclusion · source text
As with other aspects of covid-19 testing, the Government has put a significant amount of public money towards mass testing. The NAO’s December 2020 report on test and trace indicated that (leading up to October) £2.9 billion had been earmarked for mass testing, over twice the budget allocated to tracing at that time.295 At the time of the Prime Minister’s mass testing announcement in September 2020, the British Medical Journal reported that leaked Government documents indicated that a mass testing programme might cost over £100 billion to deliver.296 However, the SAGE task and finish group warned that “careful consideration” was needed to justify whether resources allocated to mass testing would achieve a larger benefit, over “investing equivalent resources” in existing test and trace activities and improving adherence to self-isolation.297 The testing shortages of Autumn 2020
Department for Science, Innovation and Technology
Department of Health and Social Care
During the summer of 2020, rates of covid infection declined markedly in most parts of...
Recommendation · source text
During the summer of 2020, rates of covid infection declined markedly in most parts of the United Kingdom. Average hospitalisations from covid fell to 119 per day on 1 August 2020 compared to 3,000 per day in early April. Yet as soon as infections began to rise in September 2020—when schools, universities and many workplaces returned after the summer holidays—the test and trace system was found once again wanting. A period of relative calm in August did not appear to have been used to anticipate and prepare for what was likely to be needed during the Autumn. 289 GOV.UK, ‘Prime Minister’s statement on coronavirus (COVID-19): 9 September 2020’, accessed 17 September 2021 290 GOV.UK, ‘Prime Minister’s statement on coronavirus (COVID-19): 9 September 2020’, accessed 17 September 2021 291 Independent, ‘Boris Johnson’s plans for mass coronavirus testing may not work, government’s top scientific adviser warns’, 10 September 2020 292 Multidisciplinary Task and Finish Group on Mass Testing, Consensus Statement for SAGE, 31 August 2020 293 GOV.UK, ‘Liverpool to be regularly tested for coronavirus in first whole city testing pilot: 3 November 2020’, accessed 17 September 2021 294 GOV.UK, Twice weekly rapid testing to be available to everyone in England: 5 April 2021, accessed 17 September 2021 295 National Audit Office, The government’s approach to test and trace in England—interim report, 11 December 2020, page 36 296 British Medical Journal, Government plans to spend £100bn on expanding testing to 10 million a day, 9 September 2020 297 Multidisciplinary Task and Finish Group on Mass Testing, Consensus Statement for SAGE, 31 August 2020 Coronavirus: lessons learned to date 69
Department for Science, Innovation and Technology
Department of Health and Social Care
Despite undergoing a large increase in testing capacity over the first lockdown period— reaching over...
Conclusion · source text
Despite undergoing a large increase in testing capacity over the first lockdown period— reaching over 200,000 daily tests by the beginning of June 2020298—the test and trace service in England then struggled to keep up with a sharp increase in demand following the reopening of schools and universities in September 2020. To tackle that increase, NHS Test and Trace had to “limit the number of tests available, lengthen turnaround times, and commission extra assistance from NHS and ‘surge’ laboratories”.299 The Government was also forced to prioritise testing for those in the NHS and in care homes, as explained by the then Executive Chair of NHS Test and Trace, Baroness Harding.300
Department for Science, Innovation and Technology
Department of Health and Social Care
During September 2020, the Science and Technology Committee heard from Baroness Harding that NHS Test...
Conclusion · source text
During September 2020, the Science and Technology Committee heard from Baroness Harding that NHS Test and Trace had “planned for a sizeable increase” but that she “[did] not think anybody was expecting” the level of demand experienced.301 She explained one reason for the surge was that a proportion of ineligible individuals were showing up to receive covid-19 tests: we have been running some surveys […] 27% [of visitors to walk-in testing sites] said they were there because they had been in contact with someone who had tested positive, but they did not have symptoms themselves.302 This should not have been quite so unpredictable given previous advice by the then Secretary of State for Health and Social Care to get a test “if in doubt and if people think they might have the symptoms”.303 The demand for testing might also have been compounded by an issue later raised by Professor Sir John Bell that “95% of people with [perceived] symptoms do not have the disease”.304
Department for Science, Innovation and Technology
Department of Health and Social Care
The NAO’s December 2020 report pointed out further that NHS Test and Trace was unable...
Conclusion · source text
The NAO’s December 2020 report pointed out further that NHS Test and Trace was unable to meet demand due to insufficient laboratory capacity as a result of: • delays in getting new laboratories up and running; • delays in delivering testing equipment, including supply chain problems with swabs, screening kits and testing reagents; and • difficulties in staffing new laboratories.305
Department for Science, Innovation and Technology
Department of Health and Social Care
Two months earlier, in July 2020, the Government Chief Scientific Adviser, Sir Patrick Vallance, told...
Recommendation · source text
Two months earlier, in July 2020, the Government Chief Scientific Adviser, Sir Patrick Vallance, told the Science and Technology Committee that extra testing capacity would be “essential” ahead of schools reopening.306 However, he suggested that the Government did 298 GOV.UK, UK reaches 200,000 coronavirus testing capacity target a day early: 31 May 2020, accessed 17 September 2021 299 National Audit Office, The government’s approach to test and trace in England—interim report, 11 December 2020, page 10 300 Oral evidence taken before the Science and Technology Committee on 17 September 2020, HC (2019–21) 136, Qq1327–1329 301 Oral evidence taken before the Science and Technology Committee on 17 September 2020, HC (2019–21) 136, Qq1314–1326 302 Oral evidence taken before the Science and Technology Committee on 17 September 2020, HC (2019–21) 136, Q1306 303 HC Deb, 20 July 2020, col 1855 [Commons Chamber] 304 Q346 305 National Audit Office, The government’s approach to test and trace in England—interim report, 11 December 2020, page 50 306 Oral evidence taken before the Science and Technology Committee on 16 July 2020, HC (2019–21) 136, Qq1149– 1154 70 Coronavirus: lessons learned to date not have the capacity to meet the potential demand of over 350,000 tests per day, a figure suggested by the Academy of Medical Sciences at the time.307 Nevertheless, Baroness Harding suggested that the level of demand encountered in September was “in none of the modelling” used by NHS Test and Trace to assess capacity.308 She told the Science and Technology Committee that capacity plans had been “based on SAGE modelling for what we should be preparing for in the autumn”, and that it was SAGE’s assessment rather than NHS Test and Trace’s.309 However, she later wrote to the Committee in a follow-up letter to clarify that SAGE had not informed the capacity targets: SAGE has not been responsible for providing modelling analysis on operational testing capacity […] In order to model and for
Department for Science, Innovation and Technology
Department of Health and Social Care
Overall, the National Audit Office concluded that NHS Test and Trace “did not plan for...
Conclusion · source text
Overall, the National Audit Office concluded that NHS Test and Trace “did not plan for a sharp rise in testing demand in early Autumn [2020]” and was therefore “unprepared.”311 Professor Chris Whitty reiterated to both Committees in December 2020 that one key learning was the need to scale up testing capacity, stating that the UK had been “caught out twice now with lack of testing, and three times would be too many”.312 By January 2021 testing capacity had reportedly increased to 800,000 per day and Baroness Harding expressed that she was “very confident” that there was sufficient capacity to handle future potential surges—citing the increased demand over Christmas as an example.313
Department for Science, Innovation and Technology
Department of Health and Social Care
The failure of the test and trace system to rise to meet even the most...
Recommendation · source text
The failure of the test and trace system to rise to meet even the most predictable of demands in Autumn 2020, especially given many weeks to prepare, suggests that lessons that were learnable during the pandemic were not applied. An urgent priority for the Government must be to satisfy itself that there is now a dependable organisation for covid testing that can both anticipate and meet future demands. The role of Test and Trace in autumn lockdowns
Department for Science, Innovation and Technology
Department of Health and Social Care
The UK has established procedures and structures to prepare for the nation’s major future risks,...
Recommendation · source text
The UK has established procedures and structures to prepare for the nation’s major future risks, including a National Risk Register, the Civil Contingencies Secretariat and the Scientific Advisory Group for Emergencies (SAGE). However, the anticipated future risk of pandemic disease focused too closely on influenza rather than diseases like SARS and MERS that had in recent years appeared in Asian countries.
Department for Science, Innovation and Technology
Department of Health and Social Care
Previous exercises to test the national response capability, namely Exercises Cygnus and Winter Willow, did...
Conclusion · source text
Previous exercises to test the national response capability, namely Exercises Cygnus and Winter Willow, did not squarely address a disease with the characteristics of covid-19. Nevertheless, some useful lessons were learned and applied, such as the drafting of legislative measures that might be needed.
Department for Science, Innovation and Technology
Department of Health and Social Care
The operation of COBR was not well-suited to the modern demands of a pandemic response.
Conclusion · source text
The operation of COBR was not well-suited to the modern demands of a pandemic response. It is especially concerning that its culture of confidentiality was considered by some to be so unreliable that alternative meetings were arranged that could command greater confidentiality among participants.
Department for Science, Innovation and Technology
Department of Health and Social Care
The Civil Contingencies Secretariat did not have adequate resources to maintain a substantial standing capability...
Conclusion · source text
The Civil Contingencies Secretariat did not have adequate resources to maintain a substantial standing capability to survey the development of potential threats, and it had a limited reach into the range of Government departments required to respond to a pandemic. The experience has been that this investment in resilience is at risk of being trumped by the day-to-day pressures of Government.
Department for Science, Innovation and Technology
Department of Health and Social Care
Protocols to share data between public bodies involved in the response were too slow to...
Conclusion · source text
Protocols to share data between public bodies involved in the response were too slow to establish and to become functional. This was especially true in the data flows from national to local government.
Department for Science, Innovation and Technology
Department of Health and Social Care
The NHS responded quickly and strongly to the demands of the pandemic, but compared to...
Conclusion · source text
The NHS responded quickly and strongly to the demands of the pandemic, but compared to other health systems it “runs hot”—with little spare capacity built in to cope with sudden and unexpected surges of demand such as in a pandemic.
Department for Science, Innovation and Technology
Department of Health and Social Care
A greater diversity of expertise and challenge—including from practitioners from other countries and a wider...
Recommendation · source text
A greater diversity of expertise and challenge—including from practitioners from other countries and a wider range of disciplines—should be included in the framing of the National Risk Register and the plans that emanate from it. Plans for the future should include a substantial and systematic method of learning from international practice during the course of an emergency.
Department for Science, Innovation and Technology
Department of Health and Social Care
A standing capability should be established in Government, or reporting to it, to scan the...
Recommendation · source text
A standing capability should be established in Government, or reporting to it, to scan the horizon for future threats, with adequate resource and counting on specialists with an independence from short-term political and administrative pressures. (Paragraph 65) Coronavirus: lessons learned to date 125
Department for Science, Innovation and Technology
Department of Health and Social Care
The Government should ensure comprehensive plans are made for future risks and emergencies.
Recommendation · source text
The Government should ensure comprehensive plans are made for future risks and emergencies. The UK should aim to be a world leader in co-ordinating international resilience planning, including reform of the World Health Organisation to ensure that it is able to play a more effective role in future pandemics.
Department for Science, Innovation and Technology
Department of Health and Social Care
The resourcing and capabilities of the Civil Contingencies Secretariat should be improved.
Recommendation · source text
The resourcing and capabilities of the Civil Contingencies Secretariat should be improved. The Civil Contingencies Secretariat should be empowered to ‘stress test’ plans and to ensure that Departments are able to carry out a contingency plan if required. The details and results of these stress tests should be included in the Cabinet Office’s annual report.
Department for Science, Innovation and Technology
Department of Health and Social Care
Arrangements should be established and tested to allow immediate flows of data between bodies relevant...
Recommendation · source text
Arrangements should be established and tested to allow immediate flows of data between bodies relevant to an emergency response with a mechanism to resolve immediately and decisively any disputes.
Department for Science, Innovation and Technology
Department of Health and Social Care
The Armed Forces should have a more central and standing role in preparing for and...
Recommendation · source text
The Armed Forces should have a more central and standing role in preparing for and responding to emergencies like pandemics, given the depth of capability and experience they have in planning, logistics and rapid mobilisation. The Civil Contingencies Secretariat should work with the Armed Forces to improve operational expertise in emergencies in public bodies.
Government response · verbatim
The government does not accept this recommendation. The government already has strong central functions dedicated to planning for and managing crises. Further, the government already makes use of the Ministry of Defence’s (MoD) planning capabilities in a crisis where required, and considers that having a standing capability dedicated solely to resilience is not necessary. From MoD's perspective it is also not desirable, as it would reduce Defence’s ability to conduct its own tasks. For the majority of emergencies requiring a response at the national level, there is a pre-nominated LGD which is responsible for both the planning and activation of central government response arrangements. In discharging these responsibilities, departments are already able to request the support of MoD and the Armed Forces in preparing for and responding to emergencies. The Armed Forces also provide considerable planning expertise on a regular basis to both CCS and other government departments for major events and crises, a process governed by the Military Aid to the Civil Authorities (MACA) process. This was seen in the preparations for leaving the European Union, Winter Response and in the early days of the pandemic, when MoD provided a network of Strategic Liaison Officers (SLOs). Spanning across the Cabinet Office, key departments and the NHS, they were able to not only assist departments to develop plans, but also to provide advice on the use of military capabilities, facilitate the MACA process and to track potential and emerging demand for military capabilities. Some existing military planning capabilities with deep expertise not easily found in government (for example Reserve Officers with the Engineer and Logistic Staff Corps) have contributed to central planning and response work. MoD, additionally, has an existing network of 18 full-time, staff-trained, Joint Regional Liaison Officers (JRLOs) to provide civil authorities with advice at the operational level. Generic planning capabilities, while invaluable, are also dependent on thorough knowledge of civilian capabilities, organisational structures, legal frameworks and working practices. These can also be provided through adherence to the UK government’s Crisis Management doctrine, rather than through the standing provision of military planners and uniform application of military planning techniques.
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Department for Science, Innovation and Technology
Department of Health and Social Care
The Government and the NHS should consider establishing a volunteer reserve database so that volunteers...
Recommendation · source text
The Government and the NHS should consider establishing a volunteer reserve database so that volunteers who have had appropriate checks can be rapidly called up and deployed in an emergency rather than needing to begin from scratch.
Department for Science, Innovation and Technology
Department of Health and Social Care
The experience of the demands placed on the NHS during the covid-19 pandemic should lead...
Recommendation · source text
The experience of the demands placed on the NHS during the covid-19 pandemic should lead to a more explicit, and monitored, surge capacity being part of the long term organisation and funding of the NHS.
Department for Science, Innovation and Technology
Department of Health and Social Care
The NHS should develop and publish new protocols for infection prevention and control in pandemics...
Recommendation · source text
The NHS should develop and publish new protocols for infection prevention and control in pandemics covering staffing, bed capacity and physical infrastructure. In developing these protocols the NHS should consider the importance of maintaining access for people accompanying some patients such as advocates for people with learning disabilities and birthing partners.
Department for Science, Innovation and Technology
Department of Health and Social Care
Comprehensive analysis should be carried out to assess the safety of running the NHS with...
Recommendation · source text
Comprehensive analysis should be carried out to assess the safety of running the NHS with the limited latent capacity that it currently has, particularly in Intensive Care Units, critical care units and high dependency units.
Department for Science, Innovation and Technology
Department of Health and Social Care
Building on the experience of staff working more flexibly during the pandemic and to enable...
Recommendation · source text
Building on the experience of staff working more flexibly during the pandemic and to enable more flexible staffing in the NHS, NHS England and Health Education England should develop proposals to better enable NHS staff to change clinical specialty mid- career and train in sub-specialties. (Paragraph 74) Lockdowns and social distancing
Department for Science, Innovation and Technology
Department of Health and Social Care
During the first three months of the covid pandemic, the UK followed the wrong policy...
Conclusion · source text
During the first three months of the covid pandemic, the UK followed the wrong policy in its use of non-pharmaceutical interventions. When the UK moved from the ‘contain’ to ‘delay’ stage, there was a policy of seeking to only moderate the speed of infection through the population—flattening the curve—rather than seeking to arrest its spread. The policy was pursued until 23 March because of the official 126 Coronavirus: lessons learned to date scientific advice the Government received, not in spite of it. Questions remain about whether the containment phase was pursued aggressively enough—we believe it could have been pursued for longer. During this period Government policy did not deviate from the scientific advice it received in any material respect. The fact that the UK approach reflected a consensus between official scientific advisers and the Government indicates a degree of groupthink that was present at the time which meant we were not as open to approaches being taken elsewhere—such as earlier lockdowns, border controls and effective test and trace—as we should have been.
Department for Science, Innovation and Technology
Department of Health and Social Care
The flattening the curve policy was implemented by introducing new restrictions only gradually and slowly,...
Conclusion · source text
The flattening the curve policy was implemented by introducing new restrictions only gradually and slowly, acting as if the spread of the virus were susceptible to calibrated control. Modelling at the time suggested that to suppress the spread of covid-19 too firmly would cause a resurgence when restrictions were lifted. This was thought likely to result in a peak in the autumn and winter when NHS pressures were already likely to be severe. In addition, it was thought that the public would only comply with severe restrictions for a limited period, and so those restrictions should not be applied before they were most needed. This approach should have been questioned at the time for a number of reasons: • it entailed people contracting covid in large numbers with hundreds of thousands of deaths likely to result; • other countries, in Asia and in Europe, including some with experience of SARS and MERS, had chosen to implement earlier, more comprehensive strategies of non-pharmaceutical interventions, which were having success; and • suppressing the spread of the virus in the early period would have bought valuable time to consider what was the best way to manage the pandemic in the medium term.
Department for Science, Innovation and Technology
Department of Health and Social Care
There are several possible explanations for what was a significant error in policy and advice...
Conclusion · source text
There are several possible explanations for what was a significant error in policy and advice early in the pandemic. These include: • the lack of adequate data on the spread of covid-19, as a result of the inadequacy of the UK testing operation; • overreliance on specific mathematical models when there were too many uncertainties; • assumptions about public compliance with rules that turned out to have underestimated the willingness to conform even for long periods; • the composition of SAGE suffered from a lack of representation from outside the United Kingdom; and • a preference for a particular UK approach may have been favoured above advice based on emulation of what was being pursued elsewhere. (Paragraph 154) Coronavirus: lessons learned to date 127
Department for Science, Innovation and Technology
Department of Health and Social Care
Science proceeds through challenge and disputation, and new theories are tested unflinchingly against evidence.
Conclusion · source text
Science proceeds through challenge and disputation, and new theories are tested unflinchingly against evidence. Yet Ministers and other advisers reported that they felt it difficult to challenge the views of their official scientific advisers. Those in Government have a duty to question and probe the assumptions behind any scientific advice given, particularly in a national emergency, but there is little evidence sufficient challenge took place. However, even when UK policy had changed to bring in a comprehensive national lockdown, the role of non-pharmaceutical interventions against covid-19 was complex, inconsistent and opaque for most of the rest of 2020.
Department for Science, Innovation and Technology
Department of Health and Social Care
The second wave of covid infections, hospitalisations and deaths during the autumn and winter of...
Conclusion · source text
The second wave of covid infections, hospitalisations and deaths during the autumn and winter of 2020/21 was significantly driven by the emergence of a new variant, known as the Kent or Alpha variant. It is likely that a “circuit break” of temporary lockdown measures if introduced in September 2020, and earlier lockdown measures during the winter, could have impeded the rapid seeding and spread of the Kent variant. However, the existence of the Kent or Alpha variant was not known by the Government until 11 December 2020 so that the justification for taking earlier measures could not rely on information available at the time.
Department for Science, Innovation and Technology
Department of Health and Social Care
Government public health communications are key to the public’s understanding of and compliance with non-pharmaceutical...
Conclusion · source text
Government public health communications are key to the public’s understanding of and compliance with non-pharmaceutical interventions. Initial messaging from the Government early in the pandemic was strong, effective and undoubtedly contributed to the success of the first lockdown. After the gradual lifting of the first lockdown from May 2020, Government guidance became increasingly complex and harder to understand, with restrictions varying in different parts of the country. Government communications did not always reflect this nuance, leading to perceived inconsistency and divergent strategies across the four nations of the UK.
Department for Science, Innovation and Technology
Department of Health and Social Care
In the early days of a crisis, scientific advice may be necessarily uncertain: data may...
Conclusion · source text
In the early days of a crisis, scientific advice may be necessarily uncertain: data may be unavailable, knowledge limited and time may be required for analysis to be conducted. In these circumstances it may be appropriate to act quickly, on a precautionary basis, rather than wait for more scientific certainty.
Department for Science, Innovation and Technology
Department of Health and Social Care
In future an approach of greater questioning and challenge should characterise the development of policy.
Recommendation · source text
In future an approach of greater questioning and challenge should characterise the development of policy. Ministers should have the confidence to follow a scientific approach themselves—being prepared to take a more robust approach to questioning and challenging the advice given. The Government and SAGE should also facilitate strong external and structured challenge to scientific advice, including from experts in countries around the world, and a wider range of disciplines.
Department for Science, Innovation and Technology
Department of Health and Social Care
In bringing together many of the UK’s most accomplished scientists, SAGE became a very UK...
Recommendation · source text
In bringing together many of the UK’s most accomplished scientists, SAGE became a very UK body. In future, it should include more representation and a wider range of disciplines, from other countries, especially those which have experienced, or are experiencing, the same emergency. (Paragraph 160) 128 Coronavirus: lessons learned to date
Department for Science, Innovation and Technology
Department of Health and Social Care
In a pandemic, the scientific advice from the SAGE co-chairs to the Government should be...
Recommendation · source text
In a pandemic, the scientific advice from the SAGE co-chairs to the Government should be published within 24 hours of it being given, or the policy being decided, whichever is the later, to ensure the opportunity for rapid scientific challenge and guard against the risk of ‘groupthink’. In addition, minutes and SAGE papers should be published within 48 hours of the meeting taking place.
Department for Science, Innovation and Technology
Department of Health and Social Care
The Government, via the World Health Organisation, should make the case for an international standard...
Recommendation · source text
The Government, via the World Health Organisation, should make the case for an international standard of reporting covid-19 deaths and a framework for reporting disease related deaths for future pandemics. (Paragraph 162) Testing and contact tracing
Department for Science, Innovation and Technology
Department of Health and Social Care
Despite being one of the first countries in the world to develop a test for...
Conclusion · source text
Despite being one of the first countries in the world to develop a test for covid in January 2020, the United Kingdom failed to translate that scientific leadership into operational success in establishing an effective test and trace system during the first year of the pandemic. Public Health England showed itself to be scientifically accomplished, but poor at delivering an operational testing system at the scale and urgency required by a pandemic.
Department for Science, Innovation and Technology
Department of Health and Social Care
Testing capacity was treated too much as a parameter rather than a variable that could...
Conclusion · source text
Testing capacity was treated too much as a parameter rather than a variable that could be changed by the Department of Health and Social Care and scientific advisers. What was being achieved in other countries, particularly East Asia, appeared to be of little interest in the initial weeks of the pandemic. This was an inexcusable oversight. It took a personal intervention by the then Secretary of State in April 2020 to drive a major increase in testing capacity.
Department for Science, Innovation and Technology
Department of Health and Social Care
The resulting requirement to abandon testing people in the community during the critical early period...
Conclusion · source text
The resulting requirement to abandon testing people in the community during the critical early period of the pandemic cost many lives for a number of reasons including because: a) many asymptomatic carriers were not tested and therefore identified and asked to isolate; b) many older people were admitted to care homes either from the community or hospitals in ignorance of their covid status or that of staff working in care homes; c) low levels of testing meant that the UK lost visibility of where the disease was spreading, among which groups and how quickly. For a crucial period our only insight into the spread of covid was by counting people so sick that they had to be admitted to hospital; and (Paragraph 234.c)) d) the receipt of a positive test result would have been likely to improve compliance with an isolation request.
Department for Science, Innovation and Technology
Department of Health and Social Care
The new Test and Trace operation eventually established in May 2020 was a step in...
Conclusion · source text
The new Test and Trace operation eventually established in May 2020 was a step in the right direction but set up much too late. Because of that delay there was huge pressure to get results quickly which meant that it followed a centralised model initially, meaning assistance from laboratories outside PHE—particularly university laboratories—was rebuffed. The same was true for contact tracing, where the established capabilities of local Directors of Public Health and their teams were Coronavirus: lessons learned to date 129 not effectively harnessed during the initial response to the pandemic, despite local approaches providing effective in places where they were pursued. It is now clear that the optimal structure for test and trace is one that is locally driven with the ability to draw on central surge capacity—but it took the best part of a year to get to that point. In short, implementation was too centralised when it ought to have been more decentralised.
Department for Science, Innovation and Technology
Department of Health and Social Care
Vast sums of taxpayers’ money were directed to Test and Trace, justified by the benefits...
Conclusion · source text
Vast sums of taxpayers’ money were directed to Test and Trace, justified by the benefits of avoiding further lockdowns. But ultimately those lockdowns happened. Were it not for the success of the Vaccine Taskforce and the NHS vaccination programme, it is likely that further lockdown restrictions would have been needed in Summer 2021.
Department for Science, Innovation and Technology
Department of Health and Social Care
We recognise that the effectiveness of test and trace in reducing transmission is likely to...
Conclusion · source text
We recognise that the effectiveness of test and trace in reducing transmission is likely to be reduced when the prevalence of the virus is high, as highlighted by Professor Whitty and others, but it is clear from the latest data and the experience of September 2020 that even at the level of operational effectiveness, NHS Test and Trace has been unable to respond to rising rates of transmission of covid-19.
Department for Science, Innovation and Technology
Department of Health and Social Care
The Test and Trace organisation has not, despite its branding, been run by the NHS,...
Recommendation · source text
The Test and Trace organisation has not, despite its branding, been run by the NHS, and has seen senior executives brought in from external bodies for short term contracts which reduces the institutional learning, from what was an intense period, that has been retained. It is a major concern that the new organisation responsible for test and trace is opaque in its structure and organisation.
Department for Science, Innovation and Technology
Department of Health and Social Care
Partly because it was set up too late, NHS Test and Trace ultimately fell short...
Recommendation · source text
Partly because it was set up too late, NHS Test and Trace ultimately fell short of the expectations set for it. It has failed to make a significant enough impact on the course of the pandemic to justify the level of public investment it received. It clearly failed on its own terms, given its aim in September to “avoid the need for a second lockdown” by contributing to a reduction in the ‘R’ number. While we acknowledge that test, trace and isolate activities are just one—albeit crucial—component of the measures undertaken to tackle covid-19, NHS Test and Trace (NHSTT) clearly failed to achieve this central objective. NHSTT has also consistently failed to reach the 72- hour turnaround time as identified as necessary by SAGE, including a significant failure in September 2020. Further, although the Government first described the impact of NHSTT on reducing ‘R’ in December, it took an unacceptably long two months before the evidence and analysis behind this assertion was made public. When it was published it became clear that the analysis was outdated, invalidating claims made at the time. The use of inaccurate data and the lack of transparency impeded effective public scrutiny at a crucial time in the pandemic.
Department for Science, Innovation and Technology
Department of Health and Social Care
The National Audit Office has stated that “to achieve value for money NHST&T must be...
Conclusion · source text
The National Audit Office has stated that “to achieve value for money NHST&T must be able to demonstrate both that the interventions it delivers are effective in achieving its objective, and that the mix of interventions is the most cost-effective use of public resources.” After 18 months and many billions of pounds of taxpayers’ funds, there is hope that the UK now has a capacity for testing and tracing that is adequate. It is a bitter irony that this point may only have been reached at the point in which the vaccination programme makes testing less of a critical component than it was previously. (Paragraph 240) 130 Coronavirus: lessons learned to date
Department for Science, Innovation and Technology
Department of Health and Social Care
Scientific excellence is not enough in test and trace programmes: the UK must develop greater...
Recommendation · source text
Scientific excellence is not enough in test and trace programmes: the UK must develop greater operational competence in deployment. In particular, the Government must ensure that both the new UK Health Security Agency and local authorities have the capability and funding to stand up both central surge capacity and locally-driven testing and contact tracing within seven days of a public health emergency being declared.
Department for Science, Innovation and Technology
Department of Health and Social Care
Public Health England and its successor bodies, as well as Ministers and their scientific advisers,...
Recommendation · source text
Public Health England and its successor bodies, as well as Ministers and their scientific advisers, should be more willing to study and emulate the practice of other countries with urgency and agility, especially during a crisis. A culture must be established that looks proactively to collaborate with other organisations, rather than to reject assistance.
Department for Science, Innovation and Technology
Department of Health and Social Care
Those responsible for future test and trace programmes should establish a culture and processes to...
Recommendation · source text
Those responsible for future test and trace programmes should establish a culture and processes to learn rapidly from errors and to act to prevent them being repeated.
Government response · verbatim
The government accepts this recommendation. UKHSA has a vital role to play in helping to identify and implement lessons learned from the management of this pandemic, both during the remaining stages and beyond, including assessing and responding to the longer-term public health impacts. While there will be further lessons to be learned from the pandemic, the drive for continuous improvement has already led to significant advances and improvements being adopted.
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Department for Science, Innovation and Technology
Department of Health and Social Care
The reactive, short-term horizon of test and trace for much of the pandemic must be...
Recommendation · source text
The reactive, short-term horizon of test and trace for much of the pandemic must be replaced by a capacity for anticipation and preparation—even during the course of an emergency.
Government response · verbatim
The government partially accepts this recommendation, while recognising that responding to unexpected events will remain a critical part of the pandemic response. Subject to securing sufficient resources, UKHSA will utilise strong surveillance capabilities, rooted in the highest quality data systems, data architecture and analytics to anticipate, prepare for, and respond to health risks. UKHSA will exploit the potential of new techniques and technologies across a range of disciplines. UKHSA will work in professional surveillance networks with partners across government, such as the Food Standards Agency, Animal and Plant Health Agency and the Department for Environment, Food and Rural Affairs, as well as in collaboration with international partners, to ensure that health threats, including those from zoonotic diseases and antimicrobial resistance (AMR), are detected earlier and responded to more effectively. As a Category 1 responder under the Civil Contingencies Act, UKHSA will work with DHSC to provide effective emergency preparedness, resilience, and response to all public health emergencies. This includes surveillance, analysis, risk assessment, management of and response to infectious disease incidents and outbreaks. UKHSA will build on the advice from its expert advisory committees where appropriate. UKHSA will also work alongside DHSC and other partners to lead a refreshed approach to pandemic preparedness (aligned to the One Health agenda), as well as contribute to a review of emergency and clinical countermeasures, and the re- procurement of the Pandemic Specific Vaccine Advance Purchase Agreement.
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Department for Science, Innovation and Technology
Department of Health and Social Care
The organisation of the bodies responsible for testing and tracing should be open and transparent...
Recommendation · source text
The organisation of the bodies responsible for testing and tracing should be open and transparent both about their operations and the basis of their decisions. (Paragraph 245) Social care
Department for Science, Innovation and Technology
Department of Health and Social Care
The covid-19 pandemic has put massive strain on a social care sector already under huge...
Conclusion · source text
The covid-19 pandemic has put massive strain on a social care sector already under huge pressure, which has a particular focus on caring for elderly people who have been at the greatest risk of death from covid.
Department for Science, Innovation and Technology
Department of Health and Social Care
Social care had a less prominent voice in Government during the early stages of the...
Conclusion · source text
Social care had a less prominent voice in Government during the early stages of the pandemic than did the NHS.
Department for Science, Innovation and Technology
Department of Health and Social Care
The discharge of elderly people from NHS hospitals into care homes without having been tested...
Conclusion · source text
The discharge of elderly people from NHS hospitals into care homes without having been tested at the beginning of the pandemic—while understandable as the NHS prepared to accept a surge of covid patients—had the unintended consequence of contributing to the spread of infection in care homes. The seeding of infections also happened as a result of staff entering care homes, and the failure to recognise this risk early is a symptom of the inadequate initial focus on social care. The lack of available testing at the time meant that the extent of spread by each route of transmission cannot be fully known and has not been conclusively determined by the report commissioned from PHE by the Government.
Department for Science, Innovation and Technology
Department of Health and Social Care
Staff shortages, the lack of testing, difficulties in obtaining PPE and the design of care...
Conclusion · source text
Staff shortages, the lack of testing, difficulties in obtaining PPE and the design of care settings to enable communal living hampered isolation and infection control and the ability to keep covid at bay. Social care staff in care homes and providing domiciliary care worked under strenuous conditions, at risk to themselves, to provide care to people. (Paragraph 291) Coronavirus: lessons learned to date 131
Department for Science, Innovation and Technology
Department of Health and Social Care
Many of these pressures on the social care sector—such as funding and workforce— are longstanding...
Recommendation · source text
Many of these pressures on the social care sector—such as funding and workforce— are longstanding and must be resolved urgently. Pressures on the social care workforce are likely to be compounded this autumn by the mandate that people working in the social care sector must be fully vaccinated to continue to provide care in residential care homes.
Department for Science, Innovation and Technology
Department of Health and Social Care
Planning for future pandemics should have a more developed and explicit consideration of the intense...
Recommendation · source text
Planning for future pandemics should have a more developed and explicit consideration of the intense interaction between the NHS and social care. The prominence of social care within the Department of Health and Social Care should be enhanced and Ministers must address the relative lack of knowledge and experience of social care within the Department and senior levels of the NHS. The Department should ensure that future policy and guidance relating to the sector is well-informed and reflects the diversity of the sector. The Department must also set out how it plans to retain the expertise of the Social Care Taskforce on a more permanent basis.
Government response · verbatim
The government partially accepts this recommendation. Preparations within adult social care have been, and will continue to be, an integral component of the government’s pandemic preparedness agenda. The capability and capacity of the Social Care Group within DHSC has grown since early 2020, now having a dedicated Director General to lead its work. A Chief Nurse for Adult Social Care was also appointed in December 2020 to provide professional leadership to the workforce as well as providing professional advice across the sector and raising the status and standards of social care nursing. The COVID-19 Social Care dashboard was launched on 22 October 2020 as a single point of information to support local, regional, and national government to understand where infection is taking place and to ascertain rapidly the measures being implemented to reduce it. As part of the ‘Adult Social Care Winter Plan 2020 to 2021’16 the Department set up a Regional Assurance Team, comprising people with significant experience within the adult social care sector, who provide direct engagement between DHSC and regional stakeholders. COVID-19 guidance for adult social care is reviewed in consultation with UKHSA, and other partners and providers to ensure guidance for the sector is clear, understandable, and well-informed by sector partners. As guidance is updated, DHSC will continue to test it with end-users to ensure it better equips care providers, care workers, commissioners, and care recipients. The Social Care Sector COVID-19 Taskforce, chaired by Sir David Pearson, formed an important part of DHSC’s response to COVID-19 in the social care sector. Its remit was to ensure the delivery of the measures outlined in the government’s ‘Social Care 16 Adult social care: our COVID-19 winter plan 2020 to 2021 – GOV.UK (https://www.gov.uk/government/publications/adult-social-care-coronavirus-covid-19-winter-plan- 2020-to-2021/adult-social-care-our-covid-19-winter-plan-2020-to-2021) Action Plan’17 (April 2020) and ‘Care Home Support Package’18 (May 2020); the latter was supported by the £600 million Infection Control Fund. The Taskforce played an important part in ensuring DHSC did all it could to reduce the risk of transmission of COVID-19 in the sector, both for those who rely on care and support and for the social care workforce, and it ensured preparedness for the second wave of COVID-19. The Taskforce ran until the end of August 2020 and reported on its findings and recommendations19 in September 2020, which helped shape the ‘Adult Social Care Winter Plan 2020 to 2021’. The Taskforce’s successor, the Social Care COVID-19 Stakeholder Group also chaired by Sir David Pearson, undertook a review of the 2020 to 2021 winter plan, and made 33 recommendations, which were incorporated by the Department in the subsequent Adult Social Care Winter Plan 2021 to 2022,20 which provided a response to each of the recommendations in its annex. Those findings and recommendations that the Taskforce and subsequent Stakeholder Group made that were not fully reflected in the Winter Plan 2021 to 2022 have helped shape DHSC’s planning for the future. DHSC worked closely with the NHS to ensure that its ‘Adult Social Care Winter Plan 2021 to 2022’ was co-ordinated and integrated. The plan, published on 3 November 2021, focused not just on COVID-19, but also on other viruses such as flu and norovirus, to ensure that those who receive social care were protected over the winter. DHSC does not currently plan to re-instate the Taskforce. However, DHSC continues to work with all organisations represented on the Taskforce, who advise and support delivery of DHSC policy. DHSC’s stakeholders have been instrumental in shaping guidance that seeks to enable people to live as safely as possible, whilst maintaining contacts and activity that enhance the health and wellbeing of service users and their family carers. 17 Coronavirus (COVID-19): adult social care action plan – GOV.UK (https://www.gov.uk/government/publications/coronavirus-covid-19-adult-social-care-action-plan) 18 Care home support package – GOV.UK (https://www.gov.uk/government/publications/coronavirus-covid-19-support-for-care- homes/coronavirus-covid-19-care-home-support-package) 19 Social care sector Covid-19 support taskforce report on first phase of the pandemic – GOV.UK (https://www.gov.uk/government/publications/social-care-sector-covid-19-support-taskforce-report-on- first-phase-of-covid-19-pandemic) 20 Adult social care: COVID-19 winter plan 2021 to 2022 – GOV.UK (https://www.gov.uk/government/publications/adult-social-care-coronavirus-covid-19-winter-plan- 2021-to-2022/adult-social-care-covid-19-winter-plan-2021-to-2022)
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Department for Science, Innovation and Technology
Department of Health and Social Care
Long term reform of social care is overdue and should be pursued as a matter...
Recommendation · source text
Long term reform of social care is overdue and should be pursued as a matter of urgency. The Government’s recent announcement on the future of social care is welcome, but the long-term future of the sector remains unresolved. We endorse the Health and Social Care Committee’s call for a 10 Year Plan for Social Care to accompany the 10 Year Plan for the NHS. It must ensure that there is parity between the health and care sectors so that social care is given proper priority in a future crisis.
Department for Science, Innovation and Technology
Department of Health and Social Care
We endorse the Health and Social Care Committee’s call for additional resources to be directed...
Recommendation · source text
We endorse the Health and Social Care Committee’s call for additional resources to be directed to social care. That Committee has made the case for an increase of £7 billion a year by 2023/4. We note that despite the Government’s recent announcement the level of new investment in social care from 2023/24 remains unclear.
Department for Science, Innovation and Technology
Department of Health and Social Care
The Government should review the provision of infection prevention and control measures, including infection prevention...
Recommendation · source text
The Government should review the provision of infection prevention and control measures, including infection prevention and control nurses, to social care and ensure that social care providers, particularly care homes, are able to conduct regular pandemic preparedness drills. The Government must ensure that care homes have isolation facilities and social care providers are able to provide safe visiting for family and friends of care home residents. (Paragraph 296) At risk communities
Department for Science, Innovation and Technology
Department of Health and Social Care
The impact of covid-19 has been uneven across the population, with some sections of society...
Conclusion · source text
The impact of covid-19 has been uneven across the population, with some sections of society suffering significantly higher illness and deaths than the nation as a whole.
Department for Science, Innovation and Technology
Department of Health and Social Care
During the initial phase of the pandemic Black, Asian and minority ethnic people experienced significantly...
Conclusion · source text
During the initial phase of the pandemic Black, Asian and minority ethnic people experienced significantly higher levels of severe illness and death from covid than was typical the population as a whole. Research conducted so far suggests that the drivers of these elevated levels of impact among Black, Asian and minority ethnic people arise from greater likelihood of jobs that come with higher exposure to covid infection; more challenging social and economic circumstances; more densely occupied housing; and comorbidities from different health conditions. These are classic features of inequality in society and in the economy. (Paragraph 331) 132 Coronavirus: lessons learned to date
Department for Science, Innovation and Technology
Department of Health and Social Care
Staff from Black, Asian and minority ethnic backgrounds are crucial to the NHS and care...
Conclusion · source text
Staff from Black, Asian and minority ethnic backgrounds are crucial to the NHS and care sectors. The covid-19 pandemic has brought the experiences of these staff into sharp focus. It is telling that the first ten NHS staff to die from covid-19 were from Black, Asian and minority ethnic backgrounds, and evidence has since confirmed that the impact of covid-19 on this section of the workforce has been significant. While the NHS has made progress in recent years, the experience of people from BAME groups during the pandemic has made it clear that inequalities persist.
Department for Science, Innovation and Technology
Department of Health and Social Care
People with learning disabilities have experienced significantly higher death rates from covid-19 than the country...
Conclusion · source text
People with learning disabilities have experienced significantly higher death rates from covid-19 than the country as a whole. Deaths have been especially high among younger adults with learning disabilities. Initial research suggests that people with learning disabilities entered the pandemic from a position of heightened vulnerability because of existing comorbidities. This was compounded by particular barriers to accessing NHS treatment during the pandemic arising from restrictions on non- covid care and limits on the ability of carers and advocates to attend hospital with people with learning disabilities.
Department for Science, Innovation and Technology
Department of Health and Social Care
Although there was never national NHS guidance to apply “Do not attempt CPR” (DNACPR) notices...
Conclusion · source text
Although there was never national NHS guidance to apply “Do not attempt CPR” (DNACPR) notices to people with learning disabilities, there have been widespread concerns that there were cases in which they have been issued inappropriately during the pandemic.
Department for Science, Innovation and Technology
Department of Health and Social Care
The Government should ensure its ‘levelling up’ agenda includes specific policies to reduce health inequalities,...
Recommendation · source text
The Government should ensure its ‘levelling up’ agenda includes specific policies to reduce health inequalities, with a particular focus on ensuring that certain groups, including people from Black, Asian and minority ethnic backgrounds, do not continue to face unequal health outcomes.
Department for Science, Innovation and Technology
Department of Health and Social Care
Oral evidence sessions
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| Date | Session and witnesses | Source |
|---|---|---|
| 4 Mar 2024 |
MPs to examine UK preparedness for future pandemics
Professor Dame Jenny Harries · UK Health Security Agency,
Professor Sir John Bell · Oxford University
|
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| 30 Nov 2022 |
Panel One; Panel Two; Panel Three; Panel Four
Clara Swinson · Department for Health and Social Care,
Dame Kate Bingham · UK Vaccine Taskforce,
Dr Dame Jenny Harries OBE · UK Health Security Agency,
Dr Thomas Waite · Department for Health and Social Care,
Michelle Dyson · Department for Education,
Neil O'Brien MP · Department for Health and Social Care,
Professor Sir John Bell · Oxford University
|
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| 10 Jun 2021 |
Oral evidence session
Rt Hon Matt Hancock · Department for Health and Social Care
|
View ↗ |
| 26 May 2021 |
Oral evidence session
Dominic Cummings, Former Chief Adviser to the Prime Minister · Cabinet Office
|
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| 26 Jan 2021 |
Oral evidence session
Sir Simon Stevens · NHS England and NHS Improvement
|
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| 2 Dec 2020 |
Oral evidence session
Lord Mark Sedwill, Cabinet Secretary (2018-2020),
Professor Dame Sally Davies, Chief Medical Officer for England (2010-2019),
Sir Mark Walport, Government Chief Scientific Adviser (2013-2017),
Sir Oliver Letwin, Cabinet Office Minister (2010-2016)
|
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| 1 Dec 2020 |
Oral evidence session
Dr Habib Naqvi · NHS Race and Health Observatory, NHS Confederation,
Iain Bell · Office for National Statistics,
James O'Rourke, family carer,
Professor Doctor Ramani Mooneshinghe · NHS England and NHS Improvement,
Professor Kevin Fenton · Public Health England,
Steve Scown · Dimensions UK
|
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| 24 Nov 2020 |
Coronavirus: lessons learnt
Alex Thomas · Institute for Government,
Clara Swinson · Department for Health and Social Care,
Dr Jenny Harries · Department for Health and Social Care,
Professor Devi Sridhar · University of Edinburgh,
Rt Hon Matt Hancock · Department of Health and Social Care
|
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| 10 Nov 2020 |
Oral evidence session
Baroness Dido Harding · NHS Test and Trace,
Dr Susan Hopkins · UK Health Security Agency,
Professor Dame Anne Johnson · University College London,
Professor Dominic Harrison · Darwen Borough Council,
Professor Gerard Krause · Helmholtz Centre for Infection Research,
Professor Jo Martin · Royal College of Pathologists,
Professor Sir Chris Ham · NHS Assembly,
Professor Sir John Bell · Oxford University
|
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| 4 Nov 2020 |
Oral evidence session
Kate Bingham · UK Vaccine Taskforce,
Professor Andrew Pollard · University of Oxford,
Professor Peter Horby · University of Oxford,
Professor Robin Shattock · Imperial College London,
Professor Wei Shen Lim · JCVI COVID-19 sub-committee
|
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| 21 Oct 2020 |
Oral evidence session
Dr Clare Gardiner · Joint Biosecurity Centre,
Dr Max Roser · Oxford Martin Programme on Global Development,
Professor Axel Gandy · Imperial College London,
Professor David Heymann · London School of Hygiene and Tropical Medicine,
Professor John Edmunds OBE · London School of Hygiene and Tropical Medicine,
Professor Mark Woolhouse OBE · University of Edinburgh,
Sir Ian Diamond · Office of National Statistics
|
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| 13 Oct 2020 |
Oral evidence session
David Pearson · Department of Health and Social Care,
Helen Spalding, carer,
Helen Whately MP · Department of Health and Social Care,
Jane Townson · UK Homecare Association,
Kathy Roberts · Care Providers Alliance,
Michelle Dyson · Department for Education,
Philip Scott, carer,
Professor David Oliver · Royal Berkshire NHS Foundation Trust,
Professor Jane Cummings · Department for Health and Social Care,
Theresa Steed · Tunbridge Wells Care Centre
|
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Written evidence
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| Reference | Date | Submitter |
|---|---|---|
| CLL0130 | 21 Oct 2021 | Dr Andrew Watts |
| CLL0129 | 21 Oct 2021 | British Medical Association (BMA) |
| CLL0127 | 17 Sep 2021 | Dr Andrew Watt |
| CLL0126 | 13 Jul 2021 | Andrew Sims |
| CLL0124 | 29 Jun 2021 | UK Pandemic Ethics Accelerator |
| CLL0123 | 29 Jun 2021 | The Health Foundation |
| CLL0122 | 29 Jun 2021 | Dr Andrew Watt |
| CLL0121 | 29 Jun 2021 | Public Health England |
| CLL0111 | 29 Jun 2021 | Julian Chisholm |
| CLL0119 | 23 Jun 2021 | General Medical Council |
| CLL0120 | 23 Jun 2021 | Sufbury & Lavenham Hotels Forum |
| CLL0118 | 16 Jun 2021 | National Care Forum |
| CLL0117 | 16 Jun 2021 | Professor Carl Heneghan, Centre for Evidence-Based Medicine |
| CLL0116 | 16 Jun 2021 | Joe Boon |
| CLL0115 | 16 Jun 2021 | Dr Theresa Anne Lawrie, The Evidence-based Medicine Consultancy Ltd |
| CLL0114 | 16 Jun 2021 | Gillian Jamieson, self-employed MBACP |
| CLL0113 | 16 Jun 2021 | Mr David Osborn |
| CLL0112 | 16 Jun 2021 | Chris Newton, Center for Immuno- Metabolism, Microbiome and Bio-Energetic Research, UK |
| CLL0110 | 9 Jun 2021 | Nigel Glassborow |
| CLL0109 | 28 May 2021 | Edward Sudall |
| CLL0108 | 27 Apr 2021 | Royal National Institute of Blind People (RNIB) |
| CLL0106 | 17 Mar 2021 | Paul E Muckelt, Dr Polly Hardy-Johnson, Dr Sofia Strommer, and Professor Mary Barker, University of Southampton |
| CLL0105 | 4 Feb 2021 | Dimensions |
| CLL0104 | 4 Feb 2021 | MedCity |
| CLL0088 | 26 Jan 2021 | Chair of NHSE Clinical Reference Group Infectious Diseases Matthias Schmid, The Newcastle upon Tyne Hospitals NHS FT |
| CLL0101 | 26 Jan 2021 | Adam Lloyd, Sickle Cell and Thalassaemia All Party Parliamentary Group |
| CLL0045 | 18 Dec 2020 | Royal Society of Chemistry |
| CLL0044 | 18 Dec 2020 | Association of Dental Groups |
| CLL0043 | 18 Dec 2020 | Professor Trudie Lang , University of Oxford |
| CLL0042 | 18 Dec 2020 | Sense |
| CLL0041 | 18 Dec 2020 | Mr Geoff Snell |
| CLL0040 | 18 Dec 2020 | Ask Research |
| CLL0039 | 18 Dec 2020 | Age UK |
| CLL0038 | 18 Dec 2020 | Professor Chris Hatton, Dept of Social Care and Social Work, Manchester Metropolitan University |
| CLL0037 | 18 Dec 2020 | Professor Chris Hatton, Dept of Social Care and Social Work, Manchester Metropolitan University |
| CLL0060 | 18 Dec 2020 | Alzheimer's Society |
| CLL0059 | 18 Dec 2020 | Centre for Britain and Europe, University of Surrey |
| CLL0057 | 18 Dec 2020 | UsforThem |
| CLL0056 | 18 Dec 2020 | Mr Bob Blackman, UK Parliament |
| CLL0055 | 18 Dec 2020 | Phil Robinson, KBioscience ltd |
| CLL0054 | 18 Dec 2020 | Institute of Civil Protection and Emergency Management |
| CLL0053 | 18 Dec 2020 | Voluntary Organisations Disability Group |
| CLL0052 | 18 Dec 2020 | Professor John Connolly, University of the West of Scotland |
| CLL0051 | 18 Dec 2020 | Dr Mike Lauder |
| CLL0050 | 18 Dec 2020 | Human Rights Watch |
| CLL0049 | 18 Dec 2020 | Dr Jennifer Bealt, The University of Manchester |
| CLL0048 | 18 Dec 2020 | Blood Cancer UK |
| CLL0047 | 18 Dec 2020 | RECOVERY trial |
| CLL0075 | 18 Dec 2020 | COVID-19 Review Observatory, Birmingham Law School, University of Birmingham |
| CLL0074 | 18 Dec 2020 | British Dental Association |
Who gave evidence
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| Witness | Organisation | Sessions |
|---|---|---|
| Professor Sir John Bell · Regius Professor of Medicine | Oxford University | 3 |
| Clara Swinson · Director General | Department for Health and Social Care | 2 |
| Michelle Dyson · Director for Qualifications, Curriculum and Extra-Curricular | Department for Education | 2 |
| Alex Thomas · Programme Director | Institute for Government | 1 |
| Baroness Dido Harding · Chair | NHS Test and Trace | 1 |
| Dame Kate Bingham · Chair (May-December 2020) | UK Vaccine Taskforce | 1 |
| David Pearson · Chair, Social Care Support Taskforce | Department of Health and Social Care | 1 |
| Dominic Cummings, Former Chief Adviser to the Prime Minister | Cabinet Office | 1 |
| Dr Clare Gardiner · Director | Joint Biosecurity Centre | 1 |
| Dr Dame Jenny Harries OBE · Chief Executive | UK Health Security Agency | 1 |
| Dr Habib Naqvi · Director | NHS Race and Health Observatory, NHS Confederation | 1 |
| Dr Jenny Harries · Deputy Chief Medical Officer for England | Department for Health and Social Care | 1 |
| Dr Max Roser · Director | Oxford Martin Programme on Global Development | 1 |
| Dr Susan Hopkins · Chief Medical Advisor | UK Health Security Agency | 1 |
| Dr Thomas Waite · Deputy Chief Medical Officer | Department for Health and Social Care | 1 |
| Helen Spalding, carer | — | 1 |
| Helen Whately MP · Minister of State | Department of Health and Social Care | 1 |
| Iain Bell · Deputy National Statistician and Director of Population and Public Policy | Office for National Statistics | 1 |
| James O'Rourke, family carer | — | 1 |
| Jane Townson · Chief Executive Officer | UK Homecare Association | 1 |
| Kate Bingham · Chair | UK Vaccine Taskforce | 1 |
| Kathy Roberts · Chair | Care Providers Alliance | 1 |
| Lord Mark Sedwill, Cabinet Secretary (2018-2020) | — | 1 |
| Neil O'Brien MP · Minister for Primary Care and Public Health | Department for Health and Social Care | 1 |
| Philip Scott, carer | — | 1 |
| Professor Andrew Pollard · Trial Chief Investigator | University of Oxford | 1 |
| Professor Axel Gandy · Chair in Statistics | Imperial College London | 1 |
| Professor Dame Anne Johnson · Professor of Infectious Disease Epidemiology | University College London | 1 |
| Professor Dame Jenny Harries · Chief Executive | UK Health Security Agency | 1 |
| Professor Dame Sally Davies, Chief Medical Officer for England (2010-2019) | — | 1 |
| Professor David Heymann · Professor of Infectious Disease Epidemiology | London School of Hygiene and Tropical Medicine | 1 |
| Professor David Oliver · Geriatric Consultant | Royal Berkshire NHS Foundation Trust | 1 |
| Professor Devi Sridhar · Professor of Global Public Health | University of Edinburgh | 1 |
| Professor Doctor Ramani Mooneshinghe · National Clinical Director for Critical Care | NHS England and NHS Improvement | 1 |
| Professor Dominic Harrison · Director of Public Health | Darwen Borough Council | 1 |
| Professor Gerard Krause · Head of Department for Epidemiology | Helmholtz Centre for Infection Research | 1 |
| Professor Jane Cummings · Adult Social Care Testing Director | Department for Health and Social Care | 1 |
| Professor Jo Martin · President | Royal College of Pathologists | 1 |
| Professor John Edmunds OBE · Professor | London School of Hygiene and Tropical Medicine | 1 |
| Professor Kevin Fenton · Public Health and Regional Director for London | Public Health England | 1 |
| Professor Mark Woolhouse OBE · Professor of Infectious Disease Epidemiology | University of Edinburgh | 1 |
| Professor Peter Horby · Professor of Emerging Infectious Diseases and Global Health | University of Oxford | 1 |
| Professor Robin Shattock · Chair in Mucosal Infection and Immunity | Imperial College London | 1 |
| Professor Sir Chris Ham · Co-Chair | NHS Assembly | 1 |
| Professor Wei Shen Lim · Chair | JCVI COVID-19 sub-committee | 1 |
| Rt Hon Matt Hancock · Secretary of State | Department for Health and Social Care | 1 |
| Rt Hon Matt Hancock · Secretary of State | Department of Health and Social Care | 1 |
| Sir Ian Diamond · National Statistician | Office of National Statistics | 1 |
| Sir Mark Walport, Government Chief Scientific Adviser (2013-2017) | — | 1 |
| Sir Oliver Letwin, Cabinet Office Minister (2010-2016) | — | 1 |
| Sir Simon Stevens · Chief Executive | NHS England and NHS Improvement | 1 |
| Steve Scown · Chief Executive | Dimensions UK | 1 |
| Theresa Steed · Home Manager | Tunbridge Wells Care Centre | 1 |
Correspondence
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Meetings & visits
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| Date | Type | Detail | Source |
|---|---|---|---|
| 7 Sep 2021 | Formal meeting (private meeting) | — · The Thatcher Room, Portcullis House | |
| 9 Dec 2020 | Formal meeting | — · The Boothroyd Room, Portcullis House |