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The Covid-19 Inquiry: A Primer

June 1st, 2020

The PM does not enjoy scrutiny. It has even taken him 10 months to attend Parliament’s Liaison Committee. Nonetheless, sometimes even the most reluctant must submit to inquiries, often led by those great favourites of politicians – judges.

68 of them between 1990 and 2017, most into tragedies so serious that an inquiry was inevitable (the Piper Alpha explosion, e-Coli outbreaks, rail crashes). Many into the NHS (murdering nurses/doctors – Allitt/Shipman, child cardiac surgery, hospital failings – Bristol, Morecambe Bay, Mid-Staffordshire). The police have endured their fair share, as have child care homes and animal disease epidemics too – BSE/foot and mouth.

The key questions any inquiry should answer are:-

  1. What happened.
  2. What went wrong.
  3. What went right.
  4. Why.
  5. Who and/or what were responsible for 2 and 3.
  6. What steps should now be taken.
  7. Who is responsible for taking them.
  8. Who will track that the persons responsible do implement the necessary steps?
  9. How will accountability for this be maintained and monitored.

Important as items 1 – 5 are, it is items 6 – 9 which ensure that such inquiries achieve something worthwhile.

What then might a Covid-19 inquiry look at?

BEFORE

  1. Project Cygnus: how the learnings, the weaknesses and risks identified by this were followed up. It identified the risks of care homes. Were the lessons learnt and implemented? If not, why not? Did any such failure adversely impact our response? A critical question this given what a high proportion of overall deaths have been in care homes, apparently as a result of government policy/instructions.
  2. The National Security Council: did it correctly identify public health risks? Did it learn the lessons from the outbreak of SARS and other epidemics? Or was it so focused on influenza epidemics that it ignored other types of infectious diseases? It’s not just generals who fight the last war. Health officials do too, something seemingly supported by those SAGE meeting minutes just released. Beware partial release, though: meeting minutes never give the full picture and release has been done for a reason. Cui bono?
  3. Public Health Infrastructure: was the organization in charge of it (PHE) fit for purpose? Did it guard its turf rather than co-operate with other providers to get the best outcomes? One of the surprising aspects is how those elements you might expect to be well done in a state run system: testing, tracing, quarantining, provision of PPE – the sorts of public goods which private profit-driven providers are not interested in (or so it is believed) – have been poor. Why? What is needed to put this right? What might be learnt from other countries – such as Germany – which seem to have handled this aspect better.

AT THE START

  1. Advisors – “We are following the science” has been the constant refrain from Ministers – until now anyway. (Does Raab realise how dangerous his admission – that it is politicians who decide – is for the government, when applied to its previous decisions?) Health/science advisors have been highly visible throughout. But there is not just one scientific discipline involved. SAGE Committee members, behavioural scientists, epidemiologists, virologists, modellers: all (and others) have had their input. Were the right people advising? How were the dangers of “groupthink” avoided? What provision was made for getting advice from other countries with direct experience of past epidemics or this one, as it developed?
  2. The Brief – “Following the science” is a bit more complicated than following a GP’s instructions. Anyone with a bit of common-sense, knows that you get the answer you want by how you frame the questions, define the terms of reference, handle the discussions. Those with the most effective authority may not be those with the most knowledge. What was the brief to the advisors? What were they asked to opine on? What were the express or implicit assumptions? What were they not asked about? Did anyone, for instance, question the assumption that a flu pandemic plan was right for a disease which might not be like flu?
  3. Understanding – Politicians are not scientists. Yet they have power, responsibility and accountability. How was the scientific advice understood (read, even), assessed, challenged? What weight was to be given to its different parts? How was it weighed up against other factors: economic, social? Who did this? how was actual data from other countries assessed? One critical step was the protection of the NHS’s ICU capacity in light of Lombardy’s experience. But other Italian experience – its success in largely stopping its spread to other regions – seems to have been ignored.
  4. Crisis management – Those who rise to the top of organisations are rarely the best crisis managers, strange as this may seem. Such people like developing their vision. They tend to panic when events take over, there is uncertainty, things change almost by the minute, there is little information on which to rely (much of it incomplete or faulty), different stakeholders demand your attention, any number of decisions need taking and changing, often at dizzying speed. New issues (not forgetting the old ones) come at you from nowhere. You have to keep your focus, your cool, your nimbleness, your eye on the big picture as well as a command of the necessary detail, your ability to manage others, your judgement and willingness to make ballsy calls and exude confidence to others that this will be got through. Effective crisis management is a real skill not just a procedure. It is not a given that our top politicians have it. Even if they did, they would need people actually to be the day-to-day crisis managers. Who was in charge of this? Were the people doing it good at it or simply those at the top of the relevant hierarchies? There seems – even at this short distance – to have been some leaden flat-footedness in the government’s response, a “frozen in the headlights” inability to act or even a fear of doing so. Afraid of criticism? Or did it fall into the trap of letting “the perfect be the enemy of the good enough”?

DURING

  1. Strategy: Was the strategy right? Initially: hand-washing and herd immunity, a fatalistic acceptance that little could be done to stop the virus’s arrival coupled with the abandonment of testing, despite the WHO’s repeated urging not to. Then the shift to the protection of NHS hospitals – a success, undoubtedly, though success is always easier to achieve if you define its terms narrowly. But there seem to be three possible failures:-

a. The delay in moving to lockdown, less stringent than elsewhere;
b. Policy towards those kept out of hospital or care home residents;
and
c. The inexplicable slowness in – or failure to – adopt measures
taken by other countries in a similar position.

  1. British exceptionalism? – Much has been made of this by some politicians in recent years. Even the government’s own extensive library of National Resilience plans refers to the inevitable cliché of the – you guessed right – “Blitz spirit” – “Resilience does not come easily but the UK has long experience. Call it what you will, but whether through the fabled ‘stiff upper lip’, ‘Blitz spirit’ or just a stubborn determination, our resilience can be seen at the forefront of our handling of emergencies.” You’d think the British had been the only people in recorded history to endure suffering stoically. A more caustic observer might suggest that over-hyped myth-making, coupled with rank amateurism more accurately described at least some of our response.

    (a) Why was Britain so slow – or reluctant to – copy other nations’ actions? Why did it not advise the use of masks – not a complete answer but better than nothing and probably essential to an effective easing of the lockdown? (b) Why did it not restrict entry or develop effective quarantine arrangements? All the more surprising in an island whose politics has been obsessed in the last few years with the determination to control arrivals here. Even now, our quarantine arrangements are anything but, and arguably far too late. (c) Why was testing abandoned? No capacity? No perceived need? Why haven’t the last 12 weeks been spent developing an effective testing, tracking and tracing system?
  2. Communication – Three areas worth looking at: (a) the difference between law and guidance, whether there should be such a gap and how this was communicated to the police; (b) the constant press conferences with Ministers putting their own interpretations on the messages; (c) the promises, the over-hyping (“world-beating?” “No, Minister. Effective will do.”), the deceit or lack of straightforwardness about figures on testing, for instance. No use blaming the media, however stupid or parti pris some journalists might be. Clear accurate communication by those in charge is their job and essential – to building confidence, as much as anything.

AND NOW

The story is not yet concluded. Easing the lockdown will provide more opportunities or even “opportunities for fresh disasters”.

Relatively few inquiries are into the conduct of government itself. There are those which take so long (Chilcot on Iraq) that everyone has already made up their minds before any report is released. This is the danger for the government – that long before all the evidence is init is blamed by voters for 50-60,000 deaths and is seen as having badly handled the epidemic – on its own terms and in comparison with others. But it is also an opportunity for the Opposition. It does not need to wait for an inquiry to start asking these questions and crafting the narrative.

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