Getting the Big Decisions Right — The Claim Game
Spin Doctors (sorry, Communications Strategists) must dream of hearing their own straplines mouthed back to them by the public. You’d imagine then that Conservative Campaign HQ will have been awash with champagne when TV Vox pops rang out with proclamations of “he got the big decisions right” in support of Boris Johnson.
Given Johnson’s subsequent departure, the line’s role as the central plank in saving ‘Big Dog,’ looks like a failure. We should however not be so sure for two reasons. Firstly, it is likely to be at the heart of Johnson’s own efforts to create his ‘legacy;’ secondly — and far more importantly — it will inevitably play a part in whatever shape the new Government takes as it tries to distance itself from the worst aspects of Johnson’s tenure whilst salvaging what it sees as the best.
The line itself of course is suitably vague. It doesn’t say what exactly these decisions were so it’s hard for anyone to argue. Assuming that no one is seriously pitching any ethical examples (from Owen Patterson through Party Gate to Lebedev), it seems clear that Johnson supporters will instead be talking Covid. Here at least, we do have some objective factual context in the form of inquiries into the Government’s handling of the pandemic. In September last year, the ‘Coronavirus — Lessons Learned to date’ report was published. It was the work of two committees — Health & Social Care and Science & Technology. Although 55% of the MPs behind it were Tory, the remainder were Labour and SNP making it a cross-party view that avoided (or at least reduced) the risk of partisanship.
We are of course very much NOT in a post Covid world so we should not be in an environment of political one upmanship. Sadly, we are. Given Johnson’s big claim, it is worth bearing in mind that one of the central pillars of the two committees’ report is that “in 2020, the UK did significantly worse in terms of Covid deaths than many countries.” For a regime that seemed obsessed with the constant positioning of its initiatives as ‘world-leading’ this is important.
So using this report as a base, how might such Covid claims stand up — right or wrong?
Pandemic Planning Decisions — Wrong (with shared responsibility)
Johnson’s Government failed to action recommendations made from three previous modelling exercises — two in 2016 and one in 2005. The results of these were kept hidden from the public until October 2020/2021 (and then only released due to a Freedom of Information Act request.) The 2016 report concluded that the UK’s preparedness was ‘not sufficient to cope with the extreme demands of a severe pandemic’ and it’s hard not to read this in the context of the earlier 2005 report which made recommendations on actions that would become only too familiar to all of us in time — the creation of virus testing programmes and the setting of travel restrictions where cases began to appear in multiple countries.
There was a problem with the very scope of these exercises anyway. The two committees’ found that pandemic modelling was “too narrowly and inflexibly based on a flu model which failed to learn the lessons from SARS, MERS and Ebola.”
Clearly, the responsibility here goes back way beyond the Johnson regime. It spans multiple Governments (the 2005 report was under Labour’s watch and the 2016 under the Tories’) but it’s hard to argue with the view of the Every Doctor organisation that the failure to “heed these warnings or implement recommendations ….is not only a failure of policy but speaks to a deeper and disturbing disregard for the safety of UK citizens and for the lives of the frontline healthcare professionals.”
Lockdown and Herd Immunity response — Wrong
The two committees relate that when the Government moved from the early ‘contain’ stage to the subsequent ‘delay’ stage it in effect bet on herd immunity which was “a serious early error” and one which specifically ignored the experience of Asian counties that had already dealt with SARS and other similar viruses. The fault for this is not laid entirely at the Government’s door but to a “groupthink” between it and the Scientists which resulted in both being insufficiently aware of alternative approaches.
The committees had similar criticism of MPs’ failure to “challenge” the fatalistic view of herd immunity. Further, and in particular, the committees were critical of the Government’s delay in implementing full lockdown which, though recognising the risk of economic harm, it defined as “inevitable” given “the absence of rigorous case isolation, a meaningful test and trace operation and robust border controls.” It saw similar failures in resisting a circuit breaker in autumn 2020 especially because the decision was contrary to scientific advice (England moved into full lockdown in October, a full month after SAGE advised the Government to do so.) We should remember too that the Government’s refusal to consider border controls continued even after the more contagious nature of the delta variant was known.
Testing and Sharing response — Wrong
The fact that community testing was stopped early on in the pandemic was described by the two committees as “a serious mistake.” The absence of testing meant the absence of data on which to plan a response. To compound this, there was a failure to share (including between national and local Government) whatever data did exist. Both errors were self-inflicted.
The committees also commented on “some major deficiencies in the machinery of government” leading to “scientific accomplishment “being “hampered by operational inadequacy.” In reality this meant that scientific advice lacked transparency, depth (especially in international scope) and challenge. Once again too, a lack of ability/willingness to share data was cited here as was the removal of “specialist expertise” from the Civil Contingencies Secretariat (the cabinet resource responsible for emergency planning.) It’s hard not to view the consequence of all this as a group of the unqualified failing to listen to the qualified and then falling to take effective action.
When it finally did arrive — a year into the pandemic — the Test and Trace programme was described by the committees as “slow, uncertain and often chaotic.” Most importantly, it failed “to prevent further lockdowns despite vast quantities of taxpayers’ money being directed to it.” There is an underlying sense of defeat being snatached from the jaws of victory given that the UK was one of the first countries in the world to have developed a test. Part of the issue here was an insistence on centralised delivery, the consequent exclusion of local public sector Directors of Public Health (despite the fact that ‘local approaches proved effective where they were used) and the use of private sector delivery companies (some of which were suspended for producing false positive results and regularly missed their targets.) In June last year the National Audit Office reported costly unused capacity, procurement without adequate tendering and inadequate data sharing. Test and Trace was a headline programme and also a headline failure made all the more noteworthy because of its enormous budget (reputedly £22bn spent from a budget of £37bn) and the fact that — as Every Doctor put it — “while emblazoned with NHS branding”, it had “almost nothing to do with the NHS.”
Social Care Sector Response — Wrong (with shared responsibility)
The committees are clear that both the Government and the NHS “failed adequately to recognise the significant risk to the social care sector at the beginning of the pandemic.” The fact that social care sits outside of the NHS — although its day-to-day practicalities have a very direct impact on it — didn’t help; this point that has been continually made by those advocating a root-and-branch restructure which has been promised — and singularly not delivered — by multiple Governments of all colours of which this is merely the latest. SAGE was short of expertise until May 2020 although the voices of care providers were loud enough had anyone been listening — they talked of lack of PPE/testing and the fact that their communal environments made isolation nigh on impossible. In this environment, the large-scale transfer of NHS patients into care homes to relieve risks in hospitals was clearly foolhardy — all of these factors were cited by the committees as contributors to “many thousands of deaths which could have been avoided.”
NHS Capacity and Treatments Response — Right (with financial caveats)
The committees lauded the NHS’ extension of ventilator availability and Intensive Care capacity, stating that “the majority of Covid-19 patients with a clinical need for hospital care received it.” Some would argue that the NHS is responsible for this success rather than the Government however it had to be funded and the achievement of course came at great cost. The Nightingale Hospitals cost over £530m and were hardly used; according to the Centre for Health and the Public Interest, a reported budget of £2bn in the first year was paid to private hospitals for access to their facilities although they were rarely used in the first two phases.
Trials in 2021 established the effectiveness and ineffectiveness of particular drugs. The committees praised the speed of these and their “vital contributions to the worldwide search for treatments that saved millions of lives.”
Support and Protection of NHS/Social Care Staff — Wrong
The committees were strangely muted on this and yet the support of those frontline workers most at risk whilst caring for the rest of us must surely be a major area of judgement. The lack of a stockpile of Personal Protective Equipment (PPE) in the first place was a further example of the failure to plan for a pandemic. The story here seems to be of another level of unpreparedness (with a dash of political dogma — the Every Doctor organsiation reports that opportunities to join EU bulk buying schemes were rejected in February and March 2020) and a breakdown in procurement processes resulting in items being unavailable or of inadequate quality. Worryingly, offers by experienced PPE suppliers were ignored whilst some contracts were placed with suppliers that were not only inexperienced but also in market sectors with absolutely no medical links. In many cases those rebuffed experienced suppliers (as well as some people who stepped forward to start manufacturing) simply went direct to hospitals and care homes thereby circumventing the official process; it was great that they did but it doesn’t say much for the Government’s procurement systems.
At the heart of this was the Government’s VIP procurement Lane. Initially the very existence was denied but gradually information emerged of a programme which the High Court later described as unlawful and “not compliant” with the “principles of equal treatment in contract procurement.” Companies using this lane had, according to the National Audit Office, a 10 times greater chance of being awarded a contract once they were introduced through “senior referrers.” Where these referrers were Ministers or party Donors, that non-compliance seemed especially striking.
Oddly, though the High Court found that the Secretary of State for Health and Social Care had acted unlawfully in conferring preferential treatment, they also found it ‘highly likely that, even if they had not been allocated to that [VIP] lane, the outcome would not have been substantially different.” For many this legal result — and the clean findings by both the Lords Commissioner and the advisor on Minister’s interests on specific cases of VIP contract awards — is not the end of the matter because of the evidence that arose from the investigation and subsequent legal case as well as the obstacles set to block both. Now that the Department of Health has confirmed that it has written off some £9bn spent on PPE, claims of efficiency won’t convince some.
It is obviously true that in a national crisis such as this, decisions had to be made quickly and some corners had to be cut in processes but the Every Doctor organisation is undoubtedly not alone in describing the PPE procurement process as comprising “layer upon layer of incompetence” and “miscommunication, corruption and wasted millions.”
Development and Rollout of the Vaccine — Right (with shared responsibility)
The committees praised the UK vaccine authorities for approaching their remit with creativity and authority, resulting in the UK being “the first Western country in the world to approve a vaccine.” The establishment of the Vaccine Taskforce (under Kate Bingham) which bought together experienced people from industry, healthcare, science and Government was also praised as was the Government’s investment in manufacturing capacity. There was admirable foresight as the foundation of all this was the establishment of the UK Vaccines Network in 2016 (long before Johnson)
The rollout of the vaccination programme was also lauded. The committees called it “one of the most effective initiatives in the history of UK science and public administration” and cited the UK as having played a major part in the “global vaccine effort which will ultimately save millions of lives.” Although the committees did not note it, the contrast to the privately delivered test and Trace programme was marked — the NHS delivered the vaccination programme via existing GP run Primary Care Networks and Clinical Commissioning Groups
Those who claim that the Johnson Government should be held responsible for over 200,000 deaths are clearly as wildly unrealistic as those who claim that it should be held responsible for none. The pandemic was a crisis for which no Government was prepared. When it suddenly arrived we had little information to go on. Its subsequent devastation exacerbated existing problems including NHS under funding and inequality (reflected in the experiences of BAME and disabled medical staff and patients), both of which existed under Johnson’s watch but also well before it.
The crisis created appalling choices that no one would want to make — how many of us would have chosen to be in Johnson’s or Hancock’s shoes? What we had a right to expect however was that our leaders would approach the crisis with a sense of seriousness, duty and focus from which political points-scoring and grandstanding would be forbidden. Similarly, we now have the right to assess Johnson’s claims. That’s called accountability and it comes with high office.
