What was Exercise Cygnus and what did it find?

This Guardian article summarises the report and contains a link to the full, though redacted, 57 page report.

David Pegg  www.theguardian.com

What was Exercise Cygnus?

Exercise Cygnus was a 2016 government simulation of a flu outbreak, carried out to war-game the UK’s pandemic readiness. It involved 950 officials from central and local government, NHS organisations, prisons and local emergency response planners. A report on the exercise was compiled the following year and distributed among its participants.

The simulation took place over three days in October 2016 and asked participants to imagine they were fighting a fictitious “worst-case-scenario” flu pandemic affecting up to 50% of the population and causing up to 400,000 excess deaths.

What did it involve?

The scenario imagined that a new virus had emerged in Thailand in June, later identified as a strain of H2N2. Within a month the World Health Organization had declared a public emergency, triggering the UK’s response plans as the world mobilised to tackle an outbreak of “swan flu”.

For the three days of the exercise, officials were told to imagine they were managing the seventh week of the pandemic, facing a peak in demand for hospital and social care. The purpose of such simulations is generally not only to test how emergency plans would hold up under strain but also to acclimatise ministers and officials to the sorts of decisions they would be forced to make.

Mock Cobra meetings were held where ministers and officials were presented with situation reports from the ground, while reporters from a fictitious news organisation called WNN published news articles, and government social media campaigns were released on “Twister”.

What were its findings?

The Cygnus report was frank about the state of the UK’s readiness. “The UK’s preparedness and response, in terms of its plans, policies and capability, is currently not sufficient to cope with the extreme demands of a severe pandemic that will have a nationwide impact across all sectors,” it found.

One problem was that while each government body participating in the exercise had its own bespoke plans, enabling a flexible and decentralised response, nobody in the centre had oversight over everyone else.

In the absence of any “overview of pandemic response plans and procedures”, participants found it much harder to shift resources between one another so as react to unexpected rises and falls in demand for services such social care beds.

At this point in the online article is a box where you can download the redacted report as a 57 page pdf or use this link: 

https://www.scribd.com/document/460161101/Cygnus-Redacted-Annex-01scribd-Redactedv3#download&from_embed

In the language of the report: “The lack of joint tactical level plans was evidenced when the scenario demand for services outstripped the capacity of local responders, in the areas of excess deaths, social care and the NHS.”

Some organisations’ plans were severely out of date and sometimes referred to coordinating their response with bodies that no longer existed. Others were relying on an institutional memory of fighting the 2009 swine flu pandemic that was slowly fading.

What about social care?

Social care appears to have been of particular concern. Participants discovered it was extremely difficult to locate capacity in the care homes sector, partly because care homes are almost entirely privately run, making it difficult to clear hospital beds by moving patients into care homes.

“Local responders also raised concerns about the expectation that the social care system would be able 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,” the report said.

Cygnus found that the social care sector was “currently under significant pressure during business as usual,” and that in the event of a pandemic staff absenteeism through illness combined with widespread infection of the vulnerable “could be very challenging”.

What did Cygnus recommend?

The report listed four areas of “key learning” and 22 further “lessons identified” from the exercise, couched as recommendations to government. While some, such as those concerning the distribution of antivirals, are not relevant to a coronavirus pandemic, others are.

The recommendations included further modelling to understand the capacity of the care sector, further work to understand how the public would react to the crisis, and the creation of a “joint-level tactical plan” to help different organisations cooperate more effectively.

Some of the Cygnus recommendations, such as preparing legislation to relax certain laws and regulations, can be clearly seen in the government’s handling of Covid-19. A Department of Health spokesperson also mentioned excess deaths as an area where additional planning had been carried out.

There are questions as to whether other recommendations were followed in full. Care sector executives told the Guardian that they were unaware of having been asked to contribute to any methodology for assessing care home capacity.

Why hasn’t the report been published before now?

Though discussed at an NHS board meeting and mentioned in a speech by the former chief medical officer, the report on Cygnus has never been published, for reasons that are not entirely clear. The health secretary at the time of the exercise, Jeremy Hunt, has said he would be relaxed about the report being published.

In a response to a freedom of information request, the Department of Health claimed that the report needed to be kept secret so as to inform policy development.

However, the current health secretary, Matt Hancock, said in an interview with LBC last month that he had been told that all of its recommendations had already been implemented, suggesting its role in informing policy was complete.