1. Lives could have been saved
The pandemic caused “grief, untold misery and economic turmoil” – all of which could have been reduced or prevented had the UK been better prepared, the inquiry’s chair, Heather Hallett, concluded.
Lives would have been spared – in particular those of the groups worst affected, including people with physical and learning disabilities, those with pre-existing conditions such as Alzheimer’s, heart disease, high blood pressure and diabetes, and people living in deprived areas and from some ethnic minority backgrounds.
As well as the deaths directly caused by the virus, the pandemic caused human suffering indirectly, including wreaking havoc on the NHS, especially on waiting lists and elective care, and increasing levels of mental illness, loneliness, deprivation and exposure to domestic violence.
She described the pandemic as “the gravest and most multi-layered peacetime emergency”.
2. Not a question of if, but when
The evidence is “overwhelmingly to the effect” that there will be another pandemic, and it is “not a question of ‘if’ … but ‘when’”.
The next pandemic may be “even more transmissible and lethal”, and is likely to occur in the near to medium future.
Without “fundamental change”, the effort in curbing the spread of coronavirus and the human, societal and economic cost suffered from it “will have been in vain”.
Lady Hallett wrote: “Never again can a disease be allowed to lead to so many deaths and so much suffering.”
3. Hubris and ‘groupthink’
Hallett wrote that in 2019, there was widespread belief, in part resulting from “groupthink” in government, that the UK was “not only properly prepared, but was one of the best-prepared countries in the world to respond to a pandemic”.
Yet, she observed, in 2020 “the UK lacked resilience”, including widening health inequalities, high levels of heart disease, diabetes, respiratory illness and obesity, and an overstretched health and social care system.
She noted that proper preparation for a pandemic “costs money” and “involves preparing for an event that may never happen” – yet this is “vastly outweighed” by the cost of not doing so. She added that the ability of the health and social care systems to respond was “constrained by their funding”.
There was a “damaging absence of focus” on useful interventions, in particular a test, trace and isolate system capable of dealing with large numbers of cases.
There was a “lack of adequate leadership” in rectifying contingency planning, including from the former health secretaries Jeremy Hunt and Matt Hancock.
“All four nations were slow to implement what were important and necessary preparations for a pandemic,” Hallett wrote, noting that resources were reallocated in 2018 towards contingency planning for a “no-deal” Brexit rather than implementing recommendations from Exercise Cygnus, the government’s 2016 pandemic readiness exercise.
4. The UK prepared for the wrong pandemic
The UK had planned for an influenza pandemic, which had “long been considered, written about and planned for” – yet Hallett noted that the Covid-19 pandemic was “not without precedent”, and disputed the idea pushed by some officials that it was an unforeseeable “black swan event”.
This preparation was “inadequate for a global pandemic of the kind that struck”, and although reasonable to prioritise, should not have excluded other potential pathogen outbreaks, which have been increasing in number. The international scientific community considered a coronavirus pandemic “a reasonable bet” before 2020, given there were four large coronavirus outbreaks that nearly became pandemics earlier in the 21st century.
The influenza response was contained in the sole government pandemic strategy, from 2011, but it was “outdated and lacked adaptability”, including paying “insufficient attention to the economic and social consequences” and to understanding which people were most vulnerable. The strategy focused on managing the impact of a milder virus where spread was inevitable rather than preventing disease and death. It was jettisoned almost immediately.
There was also too much emphasis on advising citizens and trusting them to take precautionary measures they deemed fit rather than considering “which aspects of legal coercion to protect the public may be used”, added Hallett.
She concluded: “The processes, planning and policy of the civil contingency structures within the UK government and devolved administrations and civil services failed their citizens.”
5. Radical government reforms needed
Hallett urged a “fundamental reform of the way in which the UK government and the devolved administrations prepare for whole-system civil emergencies”, and condemned the government reviews and changes since the pandemic as “fail[ing] on a number of grounds”.
She identified several “significant flaws” in the UK’s response to the pandemic, including a failure to learn from previous outbreaks of disease and properly assess risk, a lack of a coherent strategy, and too narrow a range of scientific advice given to ministers.
She said there had been “a lack of openness” in government, and pandemic-readiness exercises were “not subject to the level of independent scrutiny required”.
She recommended taking responsibility for pandemic planning away from the Department of Health and Social Care and creating a single, independent statutory body responsible for whole-system preparedness and response, drawing on both socioeconomic and scientific expertise.
This should simplify the “labyrinthine” civil emergency and resilience systems based on complex “spaghetti diagrams” of institutions, structures and systems, and replace these with a single ministerial committee or cross-departmental group of senior officials with responsibility, accountability and “a clear purpose” in each UK nation.
This should be underpinned by a new UK-wide whole-system civil emergency strategy, incorporating lessons learned from three-yearly pandemic-response exercises, taking into account health inequalities, and involving the Treasury to produce an economic strategy to consider short, medium and long-term consequences.
She recommended improving risk assessment to take into account a wider range of possibilities and not just one reasonable worst-case scenario, improving data collection, and bringing in more expertise from outside the government.
Noting that she agreed with the observation by Hunt, a former health minister, that “collectively we didn’t put anything like the time and effort and energy” into understanding the dangers of pathogens or challenging the consensus, she said in future ministers and officials “must immerse themselves in the topic, understand it and ask questions about it”.
“The aim should be to end the culture of consensus in which orthodoxy becomes entrenched,” Hallett wrote, adding that advisers should have the autonomy to express differing opinions.
Hallett will monitor closely the implementation of the recommendations in each UK nation, and expects many to be in place within six months to a year.
