As published by Conservative Home:
While the dedicated staff of our NHS and public services have managed superbly under extreme pressure, it is clear that mistakes have been made during the Coronavirus crisis.
No, let me rephrase that piece of Blairite prose. We have made mistakes. The whole British ruling class. Government, advisers (scientific and otherwise), Whitehall, the lot. And not just this Government, the previous one, and the ones before that.
So it is essential that lessons are learnt. Not just by this Government, but by future governments as well.
So we must establish a public inquiry on the handling of the pandemic.
Needless to say, the architects of our strategy throughout the crisis are nervous about the implications for them, and unsurprisingly they are saying “Yes, but not yet.” Not before the next election, or not before they retire, or move on to their next job.
Unfortunately, that will not do. The principal aim of the public inquiry is not recrimination about the past, it is preparation for the future. Pandemics come out of an apparently clear blue sky, or seem to. They are a peculiar class of threat, one whose eventual arrival is certain, but whose timing is entirely unpredictable.
The sloppy thinkers in Whitehall tend to imagine that if it is going to happen in the next 20 years, the most likely time is in about ten, so we have time to prepare for the next one. They are wrong. There is an approximately equal chance of a new pandemic in every year. There are “wet-market” style interfaces between wildlife and urban populations in Asia, Africa, and South America, and as the urban populations expand there are new opportunities for zoonotic pathogens jumping species all the time.
As public health services expand, depending too much on antibiotics, the risk of new drug resistant bacteria continues. It is probably only a limited time before we have a really virulent strain of multi-drug resistant tuberculosis, for example. We do not know whether the next threat will be bacterial, viral or fungal. We do not know whether it will be transmitted by air, by touch, or in our food. All we know is that there will be another pandemic at some entirely unspecified time in the future.
So we need to get a move on with the inquiry, and start as soon as possible. Of course the inquiry must be thorough, and must thoroughly review what went right and what went wrong in the Government’s handling of the pandemic. The public will expect it, and the Opposition will demand it. But the most important thing is that we learn the lessons and develop the template for the next crisis as soon as possible.
What is different from other inquiries is that there is a vast amount of data to design this rapid template for pandemic management, and most of it comes from abroad. Although we have had a spectacular success with our vaccination programme, and a lesser but important success with the RECOVERY programme (that delivered dexamethasone as a valuable therapy), the majority of the most successful strategies were in other countries, most obviously in East Asia.
There is a vast amount of data to evaluate all the national strategies and operational arrangements. There are reasonably accurate data on mortality, infection, recovery and excess other deaths on a daily basis for virtually every country in the world. Similarly there are accurate economic impact assessments available. Along with the genetic mutation data this allows us to track very accurately how the disease travelled, grew, was suppressed and was treated, and assess the effectiveness of dozens of different preventive and therapeutic approaches.
This argues for a two-stage inquiry. The first stage, which could start in October, should report on what the best template is within one year, giving us the best possible chance of dealing with another pandemic whenever it appears. The second stage can (and will) take years, and should review what we did right and what we did wrong.
While such inquiries are normally run by judges, the first stage of the inquiry might be better led by a leading scientist, possibly a past President of the Royal Society or some similarly recognised intellect. What it should not be is chaired by anybody who was an adviser to the Government in the crisis.
So this week the Health Secretary – Matt Hancock – announced that his Department will be setting out plans for a new UK Health Security Agency. The Agency will plan for, prevent and respond to external health threats, such as pandemics.
This is a welcome development to better protect the UK, our population, and communities from future external health hazards.
However, the Government has chosen Jenny Harries, Deputy Chief Medical Officer, to head up the Agency. I am not at all sure that this is wise. This is not a reflection on Harries, who may be brilliant. However the Prime Minister himself accepts that there were a number of missteps in the crisis.
These missteps taken by the Government were often based on questionable advice provided by the very same medical advisers who are now being handed the job of looking at what went wrong.
These public inquiries must be led in an unfettered way by an independent actor who is not consciously or unconsciously committed to the strategies that have failed in the past.
In due course the inquiry will review the errors that have plagued some of our Covid strategy. Before the current Government gets too nervous it should realise that many of the errors are rooted in the past, long before the current Prime Minister came to power, and often before the Conservative/Liberal Democrat government government took over in 2010.
So the advisory arrangements – SAGE et al – date back to the Blair years. They were first activated for the H1N1 swine flu outbreak in 2009. They frankly do not work very well. The idea of dumping all scientific advice into one committee is a bit bizarre, the sort of thing that liberal arts dominated Whitehall might do. It can often become dominated by a single strong character with a speciality that is beyond many of the members, as happened with Neil Ferguson and his poorly constructed and opaque mathematical model at the beginning of the crisis.
Similarly the Whitehall structures that are supposed to cope with crises are pretty poor too. The best demonstrator of this was the Operation Cygnus pandemic preparation exercise that was run a few years ago. This so-called command post-exercise was positively harmful, because it persuaded Whitehall that it was ready for a pandemic when all it rehearsed were the coping mechanisms – how many body bags you need, and should you have a mass mortuary in Hyde Park – rather than what you would actually do to minimise deaths. This is a generic problem, not just applicable to pandemics. Their “worst case” Brexit preparation was pretty poor too.
Some of the deep-rooted problems come a little later. The Public Health England structures were largely a product of the Lansley reforms, and they too were visibly not fit for purpose. It was their poor leadership that meant that we failed to hit the target of 10,000 test a day before the end of March, while Germany comfortably hit 15,000 a day in mid March. That incompetence denied the Government the strategies that worked so well for Germany in the first wave.
Then of course there were many decisions made on the fly during 2020. Obviously many of these were wrong, notwithstanding Matt Hancock’s cheerfully optimistic gloss earlier this week. But the public, and frankly anybody with any sense, knows that any government was making decisions based as much on guesswork as on hard data, and the public are very tolerant of that.
The primary area where an inquiry’s criticism is likely to fall is poor strategic management in, for example, the upper levels of NHS management. While their staff were doing a brilliant job, I am not too sure that the decisions on, for example, the deployment of the Nightingales and the private sector hospitals were entirely sensible.
These are the sort of things that will be unpicked over a few years by the second stage of the inquiry. The data will be complex and sometimes hard to establish, so it will take a significant time to resolve. Since it may be commenting on the decisions of individuals it is right that it takes its time. But that is all the more reason to start soon.
So my message to Boris Johnson is do not fear this inquiry: grasp this nettle soon, get the actionable insights quickly, reform and prepare accordingly, and then allow the commission to take its time doing a detailed inquiry over several years. History will judge you well for doing the right thing on this.