APPENDIX 5

Parliamentary committees review handling of aspects of pandemic

 

“No huge delay” in dealing with the pandemic, said CMO

Addressing parliament’s Health and Social Care Select Committee on 21st July, the chief medical officer, Professor Chris Whitty, stated that there had been “no huge delay in the government taking action on coronavirus”. [So the delay had been less than “huge”: “considerable”, perhaps, or “substantial” or maybe even “unconscionable”, but the professor did not elaborate on it. It was, however, the first acknowledgement of a delay and in marked contrast to earlier comments by government ministers and senior civil servants. Later in his statement he did say that the delay was “no more than you would reasonably expect…” He didn’t say who “you” referred to, and it was an interesting, if misleading, use of “reasonably”.]

The committee, chaired by former health secretary Jeremy Hunt, was told that widespread community testing earlier on in the outbreak required “an infrastructure we did not have”.

Professor Whitty blamed “incredibly limited testing capacity” and previous failure to build up the UK’s health infrastructure for why a test, trace and isolate system was not modelled ahead of the pandemic.

Asked by Mr Hunt if he was “content” the government followed his advice on staging different elements of the lockdown, he said: “Ministers at the time, who were put in an incredibly difficult position, in my view, followed the advice given by SAGE, which are clearly signposted through the minutes of SAGE.” He added that delay was “no more than you would reasonably expect for what are really very difficult things to operationalise and decide”.

One SAGE member, Wellcome Trust director Professor Sir Jeremy Farrar, said he regretted that SAGE had not been “more blunt” with its advice. Describing January and February as the “absolute critical” two months, he said that the UK was “slow” to implement measures such as increased testing and personal protective equipment for healthcare workers.

“I think the lessons that Korea, Singapore and Vietnam had learned from previous epidemics were well implemented, and they acted quicker,” he told the committee, adding: “The response to a pandemic has to be faster than the pandemic itself, otherwise you get behind the curve.” He also warned against complacency during the summer months.

The director of the Francis Crick Institute and a former president of the Royal Society, Sir Paul Nurse, told the committee there had been “pass the parcel” during the crisis. “My experience in talking to advisers and also politicians is that I have never found it too easy to find out who is actually responsible for the different parts of the strategy, and for that matter the tactics that are being put in place,” he said. Research by the institute had found “up to 45%” of healthcare workers were infected at the height of the pandemic.

He said that his institute had contacted Downing Street in March and the Health Minister, Matt Hancock, in April to emphasise the importance of regular, systematic testing of all healthcare workers, including not only frontline doctors and nurses, support staff, ambulance drivers, other healthcare providers such as the care homes, GP surgeries, community nurses and the like. “These all needed to be tested,” he said. “They were infecting their colleagues, they were infecting patients, yet they weren’t been tested systematically.”

Professor Sir John Bell of the University of Oxford said that one of the UK’s biggest failures was not being on the “front foot” in preparation for a pandemic, but praised the discovery of new therapies and the hunt for a vaccine.

Asked about the biggest failures during the pandemic, he told the committee: “The fact that we were asleep to the concept that we were going to have a pandemic, I think, shame on us. Since the year 2000 we’ve had eight close calls of emerging infectious diseases, any one of which could have swept the globe as a pandemic.”

 

“Appalling error” on transfers to care homes

In late July, the House of Common’s Public Accounts Committee described the release of 25,000 people from hospitals into care homes in the early weeks of the crisis as an “appalling error”, as individuals were not tested for the virus before they were discharged – even after there was clear evidence of asymptomatic transmission of the virus.

The cross-party committee report accused the government of throwing care homes “to the wolves”.

It said the government had been “slow, inconsistent and at times negligent” in its treatment of the social care sector in March and April, as ministers concentrated on making sure the NHS was not overloaded. Care workers were not given enough personal protective equipment as official advice on how much they should wear changed 40 times.

The government’s approach to social care in the pandemic exposed the “tragic impact” of “years of inattention, funding cuts and delayed reforms”, leaving the sector as a “poor relation” that suffered badly in the pandemic.

The committee was particularly concerned about staff in health and social care “who have endured the strain and trauma of responding to COVID-19 for many months” and who are now expected to “cope with future peaks and also deal with the enormous backlogs that have built up”.

Failure to protect staff by providing adequate PPE hit staff morale and confidence, while a lack of timely testing led to increased stress and absence.

Meg Hillier, Labour MP for Hackney South and Shoreditch, who chaired the committee, said that the failure to provide adequate PPE or testing to the millions of staff and volunteers who risked their lives to help through the first peak of the crisis was a sad, low moment in the national response.

“Vulnerable people surviving the first wave have been isolated for months, in the absence of a functional tracing and containment system. Yet there were bold and ambitious claims made by ministers about the roll-out of test, track and trace that don’t match the reality.

“The deaths of people in care homes devastated many, many families. They and we don’t have time for promises and slogans, or exercises in blame. We weren’t prepared for the first wave. Putting all else aside, Government must use the narrow window we have now to plan for a second wave. Lives depend upon getting our response right.”

 

Arrivals accelerated spread

A report by the Commons Home Affairs Select Committee, published on 5th August, said that a failure to quarantine travellers arriving in the UK in the early days of the pandemic “accelerated” the spread of COVID-19.

Between January and mid-March, non-mandatory guidance to self-isolate for 14 days was issued to travellers from designated high-risk countries, including China, Iran and Italy, but not Spain – and on 13th March this guidance was withdrawn.

The committee said evidence suggested thousands of new infections were brought in from continental Europe in the 10 days between the withdrawal of guidance and the introduction of lockdown on 23rd March.

 “It is highly likely that this contributed to the rapid increase in the spread of the virus in mid-March and to the overall scale of the outbreak in the UK,” the MPs say.

The Labour MP Yvette Cooper, who chaired the committee, said: “The government’s failure to have proper quarantine measures in place in March as the infection was spreading fast was a grave error and meant COVID-19 spread faster and reached more people. The UK was almost unique in having no border checks or quarantine arrangements at that time.”

The report criticised the Home Office and other government departments for failing to provide the committee with the scientific advice behind its decisions – despite repeated requests.

 “It is not clear, therefore, who was making the decisions about borders in March, nor on what basis such decisions were made,” the report reads. “We find that this lack of clarity is very serious and may well have contributed to mistakes being made.”

The MPs said it was understandable the government did not want to restrict flights but added that the failure to consider imposing stricter requirements on those arriving – such as mandatory self-isolation, increased screening, targeted testing or enforceable quarantine – was “a serious error”.

On 5th May, Sir Patrick Vallance, the government’s chief scientific adviser, told the health and social care committee that ahead of lockdown on 23rd March, “we saw a big influx of cases, probably from Italy and Spain, looking at the genomics of the virus in early March, seeded right across the country”.

According to research by the COVID-19 Genomics UK Consortium – which is comprised of NHS organisations, public health agencies and academic partners, including the universities of Oxford and Cambridge – Spain, France, Italy, Belgium and the Netherlands were the top five sources of imported cases of infections.

The consortium found that introduction of the virus into the UK peaked in mid-March at a time when infection rates were surging in European countries, but before the government clamped down on non-essential travel.

 

Recommendations after 2016 planning exercise largely ignored

On 7th May, The Guardian published details of a “secret” government report in 2017 that said the UK was not prepared for a pandemic and forewarned of the COVID-19 crisis in care homes.

The report was based on the findings of a government simulation of an influenza pandemic, codenamed Exercise Cygnus. It concluded that Britain was not adequately prepared for a flu-like pandemic’s “extreme demands”.

The report contained 26 recommendations, including boosting the capacity of care homes and the numbers of staff available to work in them. It also warned of the challenge facing homes asked to take in patients from hospitals.

Asked about the report on Exercise Cygnus, the health secretary, Matt Hancock, said he had been assured by officials at the Department of Health that “everything that was recommended was done”.

However, Martin Green, the chief executive of Care England, which represents the largest independent care home providers, said concerns raised by the exercise about the social care system’s ability to handle patients discharged from hospitals and the need for the largest private care providers to increase capacity were not raised by government agencies with his members.

“It beggars belief,” he told The Guardian. “This is a report that made some really clear recommendations that haven’t been implemented. If they had put in place a response to every one, we would have been in a much better place at the start of this pandemic.”

Up to 1st May, 6,686 people in care homes had died from COVID-19, with operators beset by shortages of essential PPE to protect staff and limit the spread of the virus among residents.

With a third of all COVID-19 deaths up to the beginning of May being recorded in care homes, Boris Johnson told parliament: “There is an epidemic going on in care homes, which is something I bitterly regret.”

The government kept the Exercise Cygnus report secret since it was first circulated in Whitehall in 2017, and has resisted growing calls for more transparency, which culminated in the announcement of a legal case to force ministers to release the findings.

The report, marked “Official – Sensitive”, was leaked to The Guardian which published it in full, although the names and e-mail addresses of government officials were redacted.

Public Health England ran the Cygnus exercise in October 2016, co-ordinating more than 950 people, from Department of Health ministers to teams of local emergency planners and prison officers, to test the UK’s response to a new global pandemic, envisaged to be influenza.

The exercise included four dummy meetings of COBRA, the government’s emergency response system, over three days, as ministers and officials were tasked with imagining the UK was facing the peak of infections.

A report on the exercise was produced in July 2017 and sent to all major government departments, NHS England, and the devolved administrations of Scotland, Wales and Northern Ireland.

It stated as its “key learning” that “the UK’s preparedness and response, in terms of its plans, policies and capability, was not sufficient to cope with the extreme demands of a severe pandemic that will have a nationwide impact across all sectors”.

The report recommended that a comprehensive “pandemic concept of operations” be created and that NHS England should conduct further work to prepare “surge capacity” in the health service.

It explicitly recommended that the social care system needed to be able to expand if it were to cope with a “worst-case scenario pandemic”, and that money should be ringfenced to provide extra capacity and support to the NHS.

It also said the Department of Health should consider bringing back “recently retired nurses and care workers to deal with the extra strain on the system”. Such staff could be involved in “vital tasks”, it said, including “opening up more distribution points for personal protective equipment (PPE) and working on essential communications to the public”.

Concerns were raised about the ability of the social care system to “provide the level of support needed if the NHS implemented its proposed reverse triage plans, which would entail the movement of patients from hospitals into social care facilities”.

During the COVID-19 crisis, care homes were asked, in fact pressured, to take recovering patients, leading to concerns that they might spread the infection if not properly isolated and treated, which is not always possible in care settings.

Martin Green said the matters had not been discussed. “Care England has been talking about providing extra capacity for years. We have been telling them that we have capacity and people don’t need to be in hospital. But we have got nowhere.”

In response to a freedom of information request by The Guardian in April, the Department of Health and Social Care refused to publish the report on Exercise Cygnus, claiming that it would “prohibitively impact the ability of ministers to meet with officials and external stakeholders to discuss ongoing policy development”.

A government spokesperson said that lessons from Exercise Cygnus had been learned and continued to be considered.

“The UK is one of the most prepared countries in the world and, as the public would expect, we regularly test our plans. What we learned from previous exercises helped us to rapidly respond to this unprecedented global crisis,” the spokesperson said. “We have followed a science-led action plan designed at all times to save lives and support our NHS. Our planning helped prevent the NHS being overwhelmed and means we are now moving past the peak of the virus.”

 

The view from Investors’ Chronicle

An article in Investors’ Chronicle in July said that any enquiry into the handling of the pandemic would hear from scientists close to the decision making, who are scathing about the cost of early errors. One member of the government’s scientific advisory group, SAGE, has spoken of the “complacency and arrogance” at the outset when Mr Johnson did not focus on the looming crisis.

“But governments are good at managing inquiries,” the article continued. “They have the most experience and the resources. Chaff can be thrown up to deflect blame. Was the scientific advice as clear cut as assumed? How many problems, testing capacity, for example, were due to decisions by previous regimes?

“It will play up the real successes, show that what looks clear from the outside was in fact far more nuanced and find ways to make its story better… Mr Johnson has already begun blaming others for the deaths in care homes. The chair will not wish to be seen as a stooge. But, the normal pool of judges and retired civil servants can be reasonably understanding of the pressure of governing.

“None of this means an inquiry will not be damaging. It will. But its impact may be more nuanced than many imagine. It will be shaped by those it is investigating and they are masters of misdirection, unencumbered by convention and contemptuous of critics.”

 

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