UK COVID-19 Inquiry

The governments of the UK, Scotland, Wales and Northern Ireland should each simplify and reduce the number of structures with responsibility for preparing for and building resilience to whole-system civil emergencies. The core structures should be: a single Cabinet-level or equivalent ministerial committee (including the senior minister responsible for health and social care) responsible for whole-system civil emergency preparedness and resilience for each government, which meets regularly and is chaired by the leader or deputy leader of the relevant government; and a single cross-departmental group of senior officials in each government (which reports regularly to the Cabinet-level or equivalent ministerial committee) to oversee and implement policy on civil emergency preparedness and resilience. This should be put in place within 12 months of the publication of this Report. Within 6 months of the creation of the group of senior officials, it should complete a review to simplify and reduce the number of structures responsible for whole-system civil emergency preparedness and resilience. Subsequently, within 24 months of the publication of this Report, the ministerial committee should rationalise and streamline subordinate or supporting groups and committees responsible for whole-system civil emergency preparedness and resilience. Any groups and committees retained or created to support this core structure should have a clear purpose and should report regularly about progress with, and completion of, tasks assigned to them.

The Inquiry asked UK administrations to simplify and streamline civil emergency preparedness structures. The UK Government (Cabinet Office) stated in July 2025 that the recommendation was closed, having established the National Security Council (Resilience) and refreshed catastrophic risk governance (Cabinet Office, Jul 2025). In July 2026, the Scottish Government reported that its Crisis Preparation Oversight Programme continued to support preparedness work alongside regular Cabinet updates (Scottish Government, Jul 2026). The Northern Ireland Executive stated in January 2026 that options to review its civil contingencies landscape remained under consideration (Northern Ireland Executive, Jan 2026), while the First Minister of Wales, Eluned Morgan MS, reported in July 2025 that implementation in Wales was completed (Eluned Morgan MS, Jul 2025).

The UK government and devolved administrations should work together on developing a new approach to risk assessment that moves away from a reliance on single reasonable worst-case scenarios towards an approach that: assesses a wider range of scenarios representative of the different risks and the range of each kind of risk; considers the prevention and mitigation of an emergency in addition to dealing with its consequences; provides a full analysis of the ways in which the combined impacts of different risks may complicate or worsen an emergency; assesses long-term risks in addition to short-term risks and considers how they may interact with each other; undertakes an assessment of the impact of each risk on vulnerable people; and takes into account the capacity and capabilities of the UK. In doing so, the UK government and devolved administrations should perform risk assessments that reflect the circumstances and characteristics particular to England, Wales, Scotland, Northern Ireland and the UK as a whole.

The Inquiry recommended creating a new multi-scenario approach to national risk assessment. In January 2026, the Cabinet Office reported that it had begun reviewing the National Security Risk Assessment methodology to reference varied scenarios, issued guidance on vulnerable groups, and continued developing a digital platform to analyse linked risks (Cabinet Office, Jan 2026). The department also noted progress on an alternative capability-based assessment pilot with the Royal Academy of Engineering, though joint work with devolved administrations was not mentioned (Cabinet Office, Jan 2026). It stated that the methodology review is scheduled to conclude in summer 2026 with changes implemented in 2027, alongside rollout of the digital platform and delivery of the pilot during 2026 (Cabinet Office, Jan 2026).

The UK government, working with the devolved administrations, should establish mechanisms for the timely collection, analysis, secure sharing and use of reliable data for informing emergency responses, in advance of future pandemics. Data systems should be tested in pandemic exercises. The UK government should also commission a wider range of research projects ready to commence in the event of a future pandemic. These could be ‘hibernated’ studies or existing studies that are designed to be rapidly adapted to a new outbreak. Better working with international partners should be encouraged. This should include projects to: understand the prevalence of a new virus; measure the effectiveness of a range of different public health measures; and identify which groups of vulnerable people are hardest hit by the pandemic and why.

The Inquiry asked the UK government to establish pandemic data systems and adaptable research. The Cabinet Office reported in January 2026 that the Biothreats Radar platform was launched across government, the Risk Vulnerability Tool was made available during Exercise PEGASUS, and a chair was appointed for the Health Data Research Service (Cabinet Office, Jan 2026). The Northern Ireland Executive stated in January 2026 that legislative amendments to permit sharing health datasets remained scheduled for 2025 to 2026 (Northern Ireland Executive, Jan 2026). Eluned Morgan MS stated in January 2026 that full adoption of the Welsh Emergency Care Data Set remained targeted for autumn 2026 (Eluned Morgan MS, Jan 2026).

The UK government and devolved administrations should together hold a UK-wide pandemic response exercise at least every three years. The exercise should: test the UK-wide, cross-government, national and local response to a pandemic at all stages, from the initial outbreak to multiple waves over a number of years; include a broad range of those involved in pandemic preparedness and response; and consider how a broad range of vulnerable people will be helped in the event of a pandemic.

The Cabinet Office reported in January 2026 that live participation in Exercise Pegasus, a UK-wide pandemic exercise involving all government departments and devolved administrations, concluded in November 2025 (Cabinet Office, Jan 2026). It stated that a fourth tabletop phase focusing on recovery was planned for summer 2026 to examine the impact of response decisions (Cabinet Office, Jan 2026). The department aims to deliver an outstanding post-exercise report communicating the findings and lessons in winter 2026 (Cabinet Office, Jan 2026).

For all civil emergency exercises, the governments of the UK, Scotland, Wales and Northern Ireland should each (unless there are reasons of national security for not doing so): publish an exercise report summarising the findings, lessons and recommendations, within three months of the conclusion of the exercise; publish an action plan setting out the specific steps that will be taken in response to the report's findings, and by which entity, within six months of the conclusion of the exercise; and keep exercise reports, action plans, and emergency plans and guidance from across the UK in a single, UK-wide online archive, accessible to all involved in emergency preparedness, resilience and response.

The Cabinet Office reported in January 2026 that development was underway on a UK-wide online repository for civil emergency exercise information and a cross-government lessons management framework (Cabinet Office, Jan 2026). In the same January 2026 update, the department noted that repository scoping work was expected to conclude in 2026, while the publication schedule for the Exercise PEGASUS report remained to be confirmed with publication likely in winter 2026 (Cabinet Office, Jan 2026).

The governments of the UK, Scotland, Wales and Northern Ireland should each introduce the use of red teams in the Civil Service to scrutinise and challenge the principles, evidence, policies and advice relating to preparedness for and resilience to whole-system civil emergencies. The red teams should be brought in from outside of government and the Civil Service.

The Cabinet Office reported in January 2026 that an October 2025 pilot was being applied to incorporate red teaming into the ongoing 2026 Capabilities Assessment, the Government Office for Science had established a resilience red teaming function, and remaining expert advisory groups were being stood up to review risks throughout the year (Cabinet Office, Jan 2026). The department previously stated in July 2025 that a broader red teaming capability to test departmental risk planning is due in autumn 2026 (Cabinet Office, Jul 2025).

The Government Office for Science (GO-Science) should invite the governments of Scotland, Wales and Northern Ireland to nominate a small number of representatives to attend meetings of the Scientific Advisory Group for Emergencies (SAGE) from the outset of any future emergency. The status of those representatives as either 'participant' or 'observer' should depend upon their expertise and should be a matter for SAGE to determine.

In March 2026, the Cabinet Office stated that the Government Office for Science had already made the required changes to ensure devolved Chief Scientific Advisers are invited to observe meetings from the outset of an emergency, with participant status decided by the Government Chief Scientific Adviser (Cabinet Office response, Mar 2026). Earlier that month, the Northern Ireland Executive accepted the recommendation, while the Scottish Government and Welsh Government noted it and confirmed ongoing work to agree devolved attendance arrangements (Welsh Government response, Mar 2026; Scottish Government response, Mar 2026; Northern Ireland Executive response, Mar 2026). The record holds no update since the UK Government's response of March 2026 (Cabinet Office response, Mar 2026).

The Government Office for Science (GO-Science) should develop and maintain a register of experts across the four nations of the UK who would be willing to participate in scientific advisory groups, covering a broad range of potential civil emergencies. The register should be regularly refreshed through open calls for applications.

The Inquiry recommended creating a UK-wide emergency expert register refreshed through open calls. In March 2026, the UK Government (Cabinet Office) stated that the Government Office for Science (GO-Science) already maintains an expert register for the Scientific Advisory Group for Emergencies (SAGE), is refreshing selection processes during 2026, and is working with devolved governments (Cabinet Office response, Mar 2026). The department explained in March 2026 that exploring options for open calls is a longer-term ambition due to resource requirements and the need for operational flexibility (Cabinet Office response, Mar 2026). It added in March 2026 that the register cannot be relied upon exclusively and that agile processes will continue to identify emergency expertise at pace (Cabinet Office response, Mar 2026). The record holds nothing dated later than the response of March 2026 (Cabinet Office response, Mar 2026).

During a whole-system civil emergency, the UK government and devolved administrations should each routinely publish technical advice on scientific, economic and social matters at the earliest opportunity, as well as the minutes of expert advisory groups – except where there are good reasons that prevent publication, such as commercial confidentiality, personal safety or national security, or because legal advice privilege applies.

The Cabinet Office accepted the recommendation in March 2026, stating that advisory papers and minutes will be published as and when appropriate and that it will continue reviewing guidance to define publication roles during emergencies (Cabinet Office response, Mar 2026). The Northern Ireland Executive, the Scottish Government, and the Welsh Government also accepted the recommendation in March 2026, committing to transparency and early publication in future civil emergencies (Welsh Government response, Mar 2026; Scottish Government response, Mar 2026; Northern Ireland Executive response, Mar 2026). The record holds no update since the Cabinet Office's response of March 2026 (Cabinet Office response, Mar 2026).

The Government Office for Science (GO-Science), the Scottish Government, the Welsh Government and the Department of Health (Northern Ireland) should each develop standard terms of appointment for all participants in scientific advisory groups. These terms should include: clarity around the nature of an individual's role and the extent of their responsibility, as well as the likely time commitment; payment where their time commitment means that they have to spend time away from their substantive role; access to support services; and access to advice on personal and online security, with procedures for escalating specific concerns.

The UK Government (Cabinet Office) stated in March 2026 that the Government Office for Science will review and update terms, conditions, and support for advisory group participants by 2027, including developing guidance on institutional compensation (Cabinet Office response, Mar 2026). Earlier that month, the Northern Ireland Executive, the Scottish Government, and the Welsh Government also accepted the recommendation to establish standard terms of appointment (Welsh Government response, Mar 2026; Scottish Government response, Mar 2026; Northern Ireland Executive response, Mar 2026). The record holds no update since the UK Government (Cabinet Office)'s response of March 2026 (Cabinet Office response, Mar 2026).

The UK government should bring into force in England section 1 of the Equality Act 2010, implementing the socio-economic duty. The Northern Ireland Assembly and Northern Ireland Executive should consider an equivalent provision within section 75 of the Northern Ireland Act 1998.

The Inquiry recommended enacting the socio-economic duty in England and Northern Ireland. In September 2026, Satvir Kaur, answering for Women and Equalities, stated that work continues towards commencing the duty, which includes drafting statutory guidance, and that a list of subject public authorities will be published upon commencement (Satvir Kaur, Sep 2026). In March 2026, the Northern Ireland Executive stated that exploring an equivalent provision remained under consideration while officials engaged with the Equality Commission for Northern Ireland and other stakeholders (Northern Ireland Executive response, Mar 2026).

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should each agree a framework that identifies people who would be most at risk of becoming infected by and dying from a disease and those who are most likely to be negatively impacted by any steps taken to respond to a future pandemic. The framework should set out the specific steps that could be taken to mitigate the risks to these people. Equality impact assessments should form part of this framework. Where they cannot be undertaken in a national crisis, they should be reinstated as soon as possible. Each government should agree and publish in its response to this Report how it will ensure that this framework is embedded into emergency decision-making and who will be responsible for ensuring these issues remain under consideration throughout a national crisis.

The Inquiry recommended that UK governments agree frameworks mitigating pandemic risks for vulnerable populations. In March 2026, the UK Government accepted the recommendation, stating that the Department of Health and Social Care (DHSC) will review existing guidance to identify gaps and embed frameworks into emergency decision-making (Cabinet Office response, Mar 2026). The response described plans to evaluate community measures and consult people with lived experience, but it did not mention equality impact assessments or who would be responsible for these issues during a crisis (Cabinet Office response, Mar 2026). Earlier that month, the Northern Ireland Executive, Scottish Government, and Welsh Government also accepted the recommendation in full or in principle, detailing updates to their respective emergency frameworks (Welsh Government response, Mar 2026; Scottish Government response, Mar 2026; Northern Ireland Executive response, Mar 2026). The record holds nothing dated later than the response of March 2026 (Cabinet Office response, Mar 2026).

The UK government and devolved administrations should set out in future pandemic preparedness strategies (see the Inquiry’s Module 1 Report, Recommendation 4) how decision-making will work in a future pandemic. This should include provision for COBR to be used as the initial response structure and set out how the UK government and devolved administrations will transition from managing a pandemic through COBR to managing it through separate arrangements in each nation when it becomes clear that the emergency will be longer-term. It should include provision for longer-term decision-making structures in the UK government which consist of: a strategy group to set the overall approach to each stage of the pandemic and take decisions on major interventions (eg entering and exiting lockdown); and an operational group to take decisions on the implementation of the agreed strategy throughout the pandemic. The design of these structures should include an outline of decision-making procedures for each group. The strategy should make express provision for the involvement of the UK Cabinet in the decision-making of the strategy and operational groups. It should also provide that longer-term decision-making should be conducted primarily by the UK, Scottish and Welsh Cabinets and the Northern Ireland Executive. Decision-making groups in each nation should include a minister with responsibility for representing the interests of vulnerable groups. In the UK government, the Minister for Women and Equalities may be the most appropriate minister in this regard.

The Inquiry asked governments to set out pandemic decision-making structures in preparedness strategies. In March 2026, the UK Government (Cabinet Office) stated that initial crisis responses would use Cabinet Office Briefing Rooms (COBR) before transitioning to strategy and operational committees, with the Minister for Women and Equalities representing vulnerable groups (Cabinet Office response, Mar 2026). The Northern Ireland Executive stated in March 2026 that the design of an enduring response structure remained under consideration (Northern Ireland Executive response, Mar 2026). The Scottish Government confirmed in March 2026 that its governance outline established strategic and operational structures, while the Welsh Government stated in March 2026 that decisions on devolved matters must remain with Welsh Ministers from the outset (Welsh Government response, Mar 2026; Scottish Government response, Mar 2026). The record holds nothing dated later than the response of March 2026 (Cabinet Office response, Mar 2026).

The UK government and devolved administrations should each establish formal arrangements for covering the roles of Prime Minister and First Minister (and in Northern Ireland, deputy First Minister) as applicable during a whole-system civil emergency, should the incumbent be unable to undertake their duties for any reason.

The Inquiry recommended formal leadership succession arrangements for UK and devolved leaders. In September 2026, Mr Hamish Falconer, answering for the Cabinet Office, stated that the Cabinet list on GOV.UK provides the current order of precedence of ministers (Mr Hamish Falconer, Sep 2026). In March 2026, the department accepted the recommendation and stated that the Prime Minister would put appropriate arrangements in place (Cabinet Office response, Mar 2026). Also in March 2026, the Northern Ireland Executive, Scottish Government, and Welsh Government accepted the measure, though the Executive stated that deciding pre-agreed succession arrangements remained under consideration (Welsh Government response, Mar 2026; Scottish Government response, Mar 2026; Northern Ireland Executive response, Mar 2026).

The response to a future whole-system civil emergency should be coordinated via central taskforces in each of the UK, Scotland, Wales and Northern Ireland, with responsibility for the commissioning and synthesis of advice, coordination of a single data picture and facilitation of decision-making processes. In preparation, the UK government and devolved administrations should each design the operating procedures for these taskforces, including, but not limited to, identifying the key roles needed to run the taskforces and how those roles would be appointed. The UK government should also identify the role of its taskforce in supporting decision-making procedures within the strategy and operational decision-making structures. These arrangements should be incorporated into future pandemic preparedness strategies (see the Inquiry’s Module 1 Report, Recommendation 4).

The Inquiry recommended establishing central emergency taskforces across the UK and devolved administrations. In March 2026, the UK Government (Cabinet Office) stated that operational plans for a pandemic taskforce were drafted in its Pandemic Concept of Operations, to coordinate cross-government strategy and data (Cabinet Office response, Mar 2026). The Northern Ireland Executive stated in March 2026 that it supported an enduring response structure, though its precise composition remained under consideration (Northern Ireland Executive response, Mar 2026). Earlier in March 2026, the Scottish Government accepted the recommendation in principle while formalising its operational approach, and the Welsh Government stated that it would incorporate an enduring taskforce into guidance published in early summer 2026 (Welsh Government response, Mar 2026; Scottish Government response, Mar 2026). The record holds nothing dated later than the response of March 2026 (Cabinet Office response, Mar 2026).

The UK government and devolved administrations should each develop action plans for how government communications will be made more accessible during a pandemic. As a minimum, these should include making provision for the translation of government press conferences into British Sign Language (and Irish Sign Language in Northern Ireland) and the translation of key announcements into the most frequently spoken languages in the UK.

The Inquiry asked UK administrations to develop action plans for accessible pandemic communications. In March 2026, the UK Government (Cabinet Office) stated that it had established a British Sign Language protocol for emergency announcements and updated crisis planning guidance, though translating announcements into the UK's most frequently spoken languages was not mentioned (Cabinet Office response, Mar 2026). Also that month, the Northern Ireland Executive committed to drafting accessible communications guidance by September 2026 and highlighted its use of sign language interpreters (Northern Ireland Executive response, Mar 2026). Earlier in March 2026, the Scottish Government agreed to develop an action plan including sign language and spoken language translations, and the Welsh Government pledged to add crisis advice to its inclusive communications guide (Welsh Government response, Mar 2026; Scottish Government response, Mar 2026). The record holds nothing dated later than the response of March 2026 (Cabinet Office response, Mar 2026).

The UK government should undertake a review of the Civil Contingencies Act 2004 to assess its potential role in managing future civil emergencies, including pandemics, and whether it could be employed as an interim emergency framework until more specific legislation with appropriate parliamentary safeguards is passed. The review should: examine the conditions under which the Civil Contingencies Act 2004 may be invoked in a public health emergency; consider any adjustments to the Act’s safeguards, such as the triple lock test or time limits, that would make it more adaptable to pandemics; and produce clear guidance on the Act’s application for use in civil emergencies, including pandemics, to support its use as an emergency measure in advance of specific legislation – such as a dedicated pandemic bill – being passed.

The Inquiry recommended reviewing the Civil Contingencies Act 2004 to assess its role in pandemics. In September 2026, Dan Jarvis, answering for the Cabinet Office, stated that a review assessing changes to the legislation and guidance was underway and due before Parliament by March 2027 (Dan Jarvis, Sep 2026). The department had launched a call for views in July 2026 seeking evidence on safeguards for using emergency powers in pandemics (Cabinet Office, Jul 2026). The UK Government accepted the recommendation in March 2026, agreeing to review emergency powers, safeguards, and guidance in collaboration with devolved administrations (Cabinet Office response, Mar 2026).

The UK government should invite the devolved administrations, as a matter of standard practice, to nominate relevant ministers and officials to attend COBR meetings in the event of relevant whole-system civil emergencies that have the potential to have UK-wide effects.

In its March 2026 response, the UK Government accepted the recommendation, agreeing that devolved government representatives should be invited to COBR and associated taskforce meetings where relevant, while stating that attendance decisions remain on a case-by-case basis for the meeting chair under the Amber Book (Cabinet Office response, Mar 2026). The record holds no update since the Cabinet Office's response of March 2026 (Cabinet Office response, Mar 2026).

While intergovernmental relations should be facilitated through COBR in the initial months of any future pandemic, the UK government and devolved administrations should ensure that a specific four-nations structure, concerning pandemic response, is stood up at the same time as the transition away from COBR to nation-specific decision-making structures. This should meet regularly during a pandemic and be attended by all heads of government. Arrangements for these four-nations meetings should be incorporated into future pandemic preparedness strategies (see the Inquiry’s Module 1 Report, Recommendation 4).

The Inquiry recommended creating a specific four-nations pandemic structure when transitioning from emergency response. In June 2026, Dan Jarvis, Minister for Security, stated that resilience plans had been updated to strengthen relationships with devolved administrations through the four nations ministerial group (Dan Jarvis, Jun 2026). In March 2026, the Cabinet Office agreed a four-nations structure is needed when moving away from Cabinet Office Briefing Rooms (COBR), noting discussions would finalise arrangements and ministerial representation (Cabinet Office response, Mar 2026). That month, the Welsh Government, Scottish Government, and Northern Ireland Executive each agreed to develop joint arrangements, with the Welsh Government stating agreement was achievable within 12 months (Welsh Government response, Mar 2026; Scottish Government response, Mar 2026; Northern Ireland Executive response, Mar 2026).

The UK government must ensure that there is a body (equivalent to the UK Infection Prevention and Control Cell) in place ready to be convened at the outset of any future pandemic, to consider and draft infection prevention and control guidance for healthcare settings. This body must: have clear lines of responsibility and a clear, pre-defined role and remit during a pandemic; have multidisciplinary membership, including experts in the science of viral transmission as well as those with clinical expertise; ensure that its guidance accounts for the risk of all plausible routes of transmission until sufficient evidence emerges to rule out specific routes; and ensure that guidance clearly explains the underlying rationale for the precautions recommended. Separately, the Department of Health and Social Care, NHS National Services Scotland, Public Health Wales and the Public Health Agency (Northern Ireland) should review the national infection prevention and control manuals and any future guidance to ensure that the approach to identifying risk of transmission is not confined solely to specific procedures. Emphasis should be placed on a combination of risk factors, such as rates of transmissibility, environment, setting and procedure.

The UK government (Department of Health and Social Care) accepted the recommendation in September 2026, agreeing that clear, accountable structures must support infection prevention and control decision-making during a pandemic (Department of Health and Social Care and Cabinet Office response, Sep 2026). In the same month, the Scottish Government stated that although the recommendation was not directed at it, joint work was underway on pandemic preparedness proposals and updated guidance had been published (Scottish Government response, Sep 2026). The Welsh Government confirmed in September 2026 that it is participating in a UK-wide review of advisory arrangements and will require health boards to appoint infection prevention and control directors by summer 2027 (Welsh Government response, Sep 2026). The record holds no update since the department's response of September 2026 (Department of Health and Social Care and Cabinet Office response, Sep 2026).

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should publish guidance for the implementation of visiting restrictions in hospitals in the event of a future pandemic. The guidance should identify the circumstances in which visiting restrictions should be introduced, escalated, decreased and removed alongside the measures and exemptions at each level. The guidance should be led by the following core principles: 1. Measures applied should be the least restrictive possible, both in terms of severity and the length of time for which they apply. 2. Restrictions should be decided upon and applied at the most local level possible. 3. Unless restrictions are applied at a specified level, trusts and health boards should take decisions on the severity of restrictions based on local risk assessments. 4. Communications with the public must clearly explain the measures in place and the reasons why restrictions apply. The guidance should be reviewed every three years in line with the Inquiry's Module 1 Report (Recommendation 4).

In September 2026, the UK government (Department of Health and Social Care) accepted the recommendation, agreeing to publish additional guidance on visiting restrictions to support decision-making in the event of a future pandemic (Department of Health and Social Care and Cabinet Office response, Sep 2026). The Scottish Government also accepted the recommendation in September 2026, committing to review and strengthen its guidance, while the Welsh Government noted it and committed to developing a clearer national approach (Scottish Government response, Sep 2026; Welsh Government response, Sep 2026). The record holds no update since the department's response of September 2026 (Department of Health and Social Care and Cabinet Office response, Sep 2026).

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should work with employers, including health boards and trusts, to review the availability of qualified fit testers and take steps to increase the number of fit testers accordingly. Availability should be reviewed every three years in line with the Inquiry's Module 1 Report (Recommendation 4). The Health and Safety Executive and the Health and Safety Executive for Northern Ireland should update their guidance to employers to emphasise the need to ensure that sufficient fit-testing capacity is available.

In September 2026, the Department of Health and Social Care accepted the recommendation, stating that the Health and Safety Executive intends to update its pandemic preparedness guidance for employers by the end of 2026 (Department of Health and Social Care and Cabinet Office response, Sep 2026). In September 2026, the Scottish Government accepted reviewing qualified fit-tester availability while accepting in principle proposals to increase tester numbers, and the Welsh Government noted the recommendation while assessing capabilities across health and social care (Scottish Government response, Sep 2026; Welsh Government response, Sep 2026). The record holds no update since the department's response of September 2026 (Department of Health and Social Care and Cabinet Office response, Sep 2026).

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive must ensure that health data and digital systems have the capability to identify individuals at high risk of morbidity or mortality from a pandemic disease quickly and accurately in a future pandemic. This should include action to improve health data systems and patient record-keeping by: improving patient data by enabling more granular diagnostic coding; ensuring that care records are compatible across primary and secondary care; and enabling secure data-sharing and linkage across multiple health datasets and systems for identifying individuals at high risk.

In September 2026, the Department of Health and Social Care accepted the recommendation, stating that its 10 Year Health Plan and existing data policy work provide a strong foundation to achieve the required improvements to data systems (Department of Health and Social Care and Cabinet Office response, Sep 2026). The Scottish Government also accepted the recommendation in September 2026, noting that adopting ICD 11 standards will be examined next financial year, while the Welsh Government noted it and committed to provide a more detailed update in May 2027 (Scottish Government response, Sep 2026; Welsh Government response, Sep 2026). The record holds no update since the department's response of September 2026 (Department of Health and Social Care and Cabinet Office response, Sep 2026).

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should work with their respective public health agencies and healthcare employers to develop nation-specific mechanisms to collect, analyse and publish data systematically on the deaths of healthcare workers in the event of a pandemic outbreak. The UK Statistics Authority should work with data providers to ensure that the data are comparable across the four nations of the UK.

In September 2026, the Department of Health and Social Care accepted the recommendation, stating that it will take a "proportionate, staged approach" to implementation (Department of Health and Social Care and Cabinet Office response, Sep 2026). The Scottish Government accepted the recommendation in principle in September 2026, proposing a phased approach to test data linkage while noting that differing data sources may prevent complete comparability across the UK (Scottish Government response, Sep 2026). The Welsh Government also agreed in September 2026 to adopt a staged approach, stating that practical, legal, and information governance issues must still be resolved before establishing a reporting mechanism (Welsh Government response, Sep 2026). The record holds no update since the department's response of September 2026 (Department of Health and Social Care and Cabinet Office response, Sep 2026).

Each of the four UK public health or health security agencies should work together to: maintain accurate, UK-wide insight into the state of vaccine uptake and hesitancy; and understand the measures proven to be effective in increasing uptake across the four nations of the UK. There should be collaboration and some standardisation in the agreed approach across the four nations for monitoring and publishing routine vaccine uptake and vaccine confidence levels in order to better understand regional variations and patterns. Each nation should set and regularly review its minimum acceptable standards of vaccine uptake, which would trigger targeted uptake campaigns if not reached. The effectiveness of vaccine uptake campaigns should be evaluated against clear, standardised measures. This includes retrospective analysis of the Covid-19 uptake campaigns, as well as evaluation of routine vaccination uptake campaigns.

The Inquiry asked the UK Health Security Agency to monitor and evaluate vaccine uptake. In September 2026, the Northern Ireland Executive had not published a response to the Module 4 report of April 2026 on its publications list (Northern Ireland Executive response, Sep 2026). In September 2026, the Scottish Government had not published a response to the report within its collection of Inquiry responses (Scottish Government response, Sep 2026). In September 2026, the Welsh Government had not published a response to the report on its module responses page (Welsh Government response, Sep 2026). The record holds nothing dated later than the response of September 2026 (Welsh Government response, Sep 2026).