- The Government says that “data from the four nations are not directly comparable”, but an Imperial College study in October found that “England, Wales and Scotland had among the highest rate of deaths from all causes, including Covid-19, as a result of the first wave of the pandemic”. The governments of all three appear to be in the same boat.
- The core pandemic policy has been to “protect the NHS”. This is a political fundamental: the public would not have tolerated, and the Government would not have survived, Lombardy-style TV pictures of emergency rooms closed, intensive care units collapsing, patients dying on trolleys – and choking to death in care parks or at home without palliative care.
- There is therefore a strong case, as Liam Fox argued on this site on Monday, for running the NHS in England, as elsewhere, less “hot” in future. (And, talking of the former Trade Secretary’s article, the UK and other countries need to work on comparable case, hospitalisation and death figures.)
- Doing so would certainly have helped ameliorate some of the worst of the care homes disaster, and the contribution made by agency staff moving from one setting to another raises a political intractable again: social care reform.
- If the bedrock policy is indeed “to protect the NHS”, it makes no sense to claim that Ministers’ decisions are “guided by the science”: protecting the NHS first and foremost is a political decision. It appears that Ministers followed the advice of SAGE and the government scientific officers more closely at the start of the pandemic than recently.
- In the absence of vaccines, test and trace remains a better strategic response to a pandemic than lockdowns or voluntarism. (Germany has the 38th and Sweden the 17th worst deaths per million.) It is clearly unlikely to work unless it is applied very early, more drastically, and makes more use of local government and if necessary the armed forces.
- The failure of test and trace to deliver to the required standard was part of the reason for the abolition of Public Health England. The work of NHS staff on the ground has been heroic, the operations of the NHS as an institution more mixed. Covid-19 has re-raised the question of whether the Lansley reforms were mistaken in putting parts of the system at arms-length from political control .
- If the NHS is not menaced by collapse, test and trace systems don’t work as well as they should, and no vaccines are available, the strategic choices narrow to lockdowns or voluntarism. In those circumstances, Ministers need advice from economists as well as epidemiologists, and SAGE needs widening in future to this effect – as it has conceded itself.
- The Civil Contingencies Act would have allowed for more Parliamentary scrutiny of the Government than the Coronavirus Act has done. There is a very good case for using it during any future pandemic. Virtual proceedings and the absence of many MPs from Westminster, while necessary, have done nothing to help hold the Government to account, and civil liberties have undoubtedly been compromised.
- It is understandable that no agreed programme for national online learning, backed by Ofsted inspections, was available when the pandemic broke. But there still isn’t one second time round, and preparations for one in future will be essential.
- The Government’s quarantine airports plan will need to be policed – which is a reminder that unpreparedness and delivery failure have stretched across the whole of government: the NHS app bungle, the software cock-up that led to the under-reporting of 16,000 cases, the early problems with PPE, controversies over contracts.
- Ministers should set out a timetable for an inquiry once it becomes apparent that the vaccination programme is working, variants are under control, and hospitalisation returns to normal: that looks like being some point during the spring.
- A Parliamentary inquiry would risk dissolving along partisan lines. A judge-led fact-finding inquiry looks like the only practicable alternative. There is a case for it offering protection against self-incrimination, as in parts of the Grenfell inquiry, in order to help get at the truth. If the inquiry suggests in its report that Ministers were gravely at fault they will be compelled to resign in any event.
We’ve tried above to look to the future rather than to blame any of the governments or administrations involved. And the success of the vaccine programme should be weighed against the failure represented by the death figures – as must the nightmarish burden for Ministers as they, like their equivalents abroad, have sought to grapple with the biggest pandemic in a century.
But as Bernard Jenkin said to this site yesterday: “government must prepare for a mass of possible events, and many of these will be unknown to the public”. Success against future pandemics may depend on the priority which Ministers give to those preparations against the claims of a mass of competitors.