UK must learn lessons from poor pandemic response, says former Cabinet secretary

By on 28/09/2020
Lord O’Donnell, pictured at GGF’s 2019 Global Government Summit, has questioned ministers’ decision to abolish the UK’s public health agency

Almost every country has suffered during the pandemic – but the UK has been particularly badly hit, with huge damage to people’s health, incomes and wellbeing. Matt Ross hears Lord O’Donnell, former head of the civil service, explore some of the reasons why

Whichever way you look at it, the UK government’s response to the coronavirus pandemic has failed. “On excess deaths, the economy and wellbeing, it’s quite clear that we do very badly on all of them,” said Lord O’Donnell. “If we’d done well at one and not another, you might think that politicians had made different trade-offs in this country compared to others. But the fact that we’re doing badly on all of them suggests that we have a lot to learn from other countries.”

Gus O’Donnell, the former UK Cabinet secretary and head of the civil service, was considering the UK’s response to COVID-19 in the annual IFS lecture last week – and he didn’t paint a happy picture. The death rate per million people is twice the European average; the UK has seen the greatest falls in both GDP and wellbeing among the major economies; and the pandemic is worsening existing inequalities.

IFS research, said O’Donnell, shows that “in the UK and US, those in more precarious jobs have been more likely to be out of work as a result of the virus, and the impact on women has been more severe”. This is not true in Germany, he added, where “neither your gender nor your level of education are predictors of job security.” And, pointing out the damage caused by closing schools, the peer warned that “the pandemic is at risk of reversing many of the hard-won gains in closing gaps in educational outcomes between rich and poor students.”

Scientific advice too narrow

So what’s gone wrong? In O’Donnell’s view, one of the government’s early errors was to allow medical scientists to dominate its Sage advisory group, with the result that they “have informed strategy far more than other branches of science.” The medics’ priority, naturally enough, was to minimise infections and protect health services – “but this is a mixed crisis, involving health, economic and social factors,” he said. “Multiple analytical approaches need to feed into the guidance given to ministers. And ministers need guidance on the trade-offs that are involved, as well as how to make consistent decisions as part of an over-arching strategy.”

Sage’s size and range of expertise have since been expanded, O’Donnell noted, but – as he told GGF in an April interview – the government’s early reliance on medical experts left economic and social considerations under-weighted in decision-making. And the former civil service chief questioned the wisdom of some Sage advice, noting that it had initially suggested “the coronavirus would be experienced as a flu-like wave. Sage does not seem to have been willing early on to investigate alternative, suppression measures, which were successful in places like South Korea.” When the government realised how many people could die in an unconstrained pandemic, it steered away from the ‘herd immunity’ strategy – but precious time had been lost.

Stop over-promising

In another important error, said O’Donnell, “ministers have frequently broken one of the cardinal rules: they have over-promised and under-delivered.” He mentioned health secretary Matthew Hancock’s pledge to deliver 100,000 COVID tests per day, and the prime minister’s talk of a “moonshot” plan to test 10m daily. “Talk of moonshots shows they’ve not learned this lesson yet,” he said, noting that creating ambitious headline targets “puts enormous pressure on the system, and results in behaviours which… hit the target but miss the point.” In the case of the 100,000 tests pledge, huge efforts were put into boosting testing capacity – but problems around test management, data handling and accessibility have kept the number of test results well below this figure.

Hancock’s April promise was prompted by the UK’s failure to boost testing capacity as the pandemic loomed – and O’Donnell questioned the early decision by Public Health England (PHE), which covers preventive health work, to limit testing to government labs. But he challenged “political attempts to blame it for our COVID response”: Hancock has announced that PHE will be abolished, and replaced with a National Institute for Health Protection.

Matthew Hancock, the UK health secretary, has announced the abolition of Public Health England – a decision questioned by Lord O’Donnell. Picture courtesy of Number 10

The wrong answer

This institute will oversee the national test and trace operation and the new Joint Biosecurity Centre, but PHE’s behavioural work “will go somewhere else, as yet unspecified,” said O’Donnell. This decision “goes firmly against the collaborative, human science approach I’ve been advocating,” he said, noting that “constraining the pandemic is achieved – until we have a vaccine and better treatments – mostly by changing behaviour.”

While ministers have suggested that PHE was insufficiently accountable to ministers, he added, the new body will adopt exactly the same executive agency status. “It’s much more likely that the problem lies in how a central authority liaises with multiple local and private providers,” he commented. “In addition, perhaps too much faith was put in digital solutions led out of the newly established NHSX [digital health unit], without realising the efficacy of low-technology tracing.”

Act on warnings

As elected leaders consider how best to learn lessons from the UK’s performance, O’Donnell warned against “blame games” and called for “an inquiry that looks at our capacity to deal with crises – not necessarily the last crisis. One of our mistakes is always to fight the last war.” Threat assessment exercises had long put pandemics at the top of the risk register, he noted, but “we didn’t follow through on the lessons that came out of those.” There should, he argued, be “a mechanism in government that not only identifies the key risks, but also makes sure that you undertake the actions that are necessary.”

When budgets are under pressure, O’Donnell explained, “it’s very hard to put aside resources which you hope will never be used” – so dedicated supplies and services are slowly squeezed. “It’s always going to be very tempting to raid such pots. So finding structural ways to keep aside contingencies – to think of them as insurance policies, backed by real resources – is a very tough challenge.”

Looking to the future, the former Cabinet secretary urged ministers to learn lessons from nations that have suffered less damage during the pandemic. “Any judgement we make now has to be very provisional, but if you look at what’s happened so far – and that weight of evidence across health, economic and wellbeing data – you have to ask yourself: is something going wrong?” he concluded. “If we’re going to manage this crisis, we have to learn lessons from the first part to make sure that the second part – which we’re now clearly going into – is managed better.”

About Matt Ross

Matt is a journalist and editor specialising in public sector management, policymaking and service delivery. He was the editor of Civil Service World 2008-14, serving an audience of senior UK officials; and the features editor of Regeneration & Renewal 2002-08, covering urban regeneration, economic growth and community development. He has also been a motoring and travel journalist, and now combines his role as editorial director of Global Government Forum with communications consultancy, marketing and journalism work for publishers, public sector unions and private sector suppliers to government.

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