“the handling of the pandemic represents the most egregious failure of British governance in living memory.” Professor Sir Ivor Crewe, from an essay entitled, “Points of failure, lessons for the future”.
Building a resilient state: A collection of essays by:
Deborah Cadman OBE, Professor Sir Ivor Crewe, Professor Ian Goldin, Andy Haldane, Suzanne Hall, Danny Kruger MBE MP, Rt Hon Baroness Nicky Morgan, Professor Nick Pearce, Charlotte Pickles, Dr Rod Thornton and Dr Marina Miron, Rt Hon Lord William Wallace
Published by Reform the Whitehall think tank for public reform – October 2020
All the essays are worth reading: Owl posts just one:
Points of failure, lessons for the future
Professor Sir Ivor Crewe
Thomas Hobbes published Leviathan in 1651 in the aftermath of the chaos of the English Civil War. A revised edition appeared in 1668, shortly after the Great Plague of 1665-66 had killed 100,000 in London alone, and the Great Fire had devasted the Medieval city. Leviathan was the precursor of the theory of the modern state as a social contract: the establishment of a single, unified sovereign, with absolute power over its subjects, was necessary to transcend the “state of nature” in which a “war of all against all” would render people’s lives “solitary, poor, nasty, brutish, and short”.
The foremost purpose of the modern, democratic state is the security and welfare of its population, notably protection from the ravages of civil disorder, external threat, natural disasters, and epidemics. In return the population pays taxes, obeys the law, complies with regulations and (in the past) accepted military conscription and rationing among other impositions.
The UK State has had a creditable record since World War II. It repulsed a German invasion, maintained a liberal democratic order, rebuilt the economy and constructed the welfare state. The pre-war scourges of destitution, mass unemployment and epidemics did not return, although occasionally it was a close-run thing.
Governments have dealt effectively with the lesser-scale emergencies of floods, mad cow disease and terrorism, which appears to be contained. The jury is out on climate change, which is work in progress.
The COVID-19 pandemic is the gravest threat to the health and livelihoods of the British people since 1945. It poses the most demanding test of the State’s resilience and good governance in our lifetime. Any judgement of its performance should be tempered by recognition of the speed with which the pandemic spread, unavoidable uncertainty about the character and trajectory of this novel virus, and the exceptionally high-stakes trade-off between protecting public health and sustaining businesses and employment.
Moreover, a full and detailed account of the Government’s major decisions is not available and what currently appear to be errors and deficiencies may be vindicated in retrospect.
Despite these caveats, the handling of the pandemic represents the most egregious failure of British governance in living memory. The major failures include:
• The continuing lack of a clear and coherent strategy, understood by decision-makers and public alike.
• The delay of the lockdown until mid-March.
• The inadequate supply of personal protective equipment (PPE) to medical staff and other key workers.
• The offloading of untested elderly hospital patients to care homes.
• The failure, after six months, to establish an efficient national system of testing, tracing and isolation (TTI).
• The squandering of public trust in government measures of protection, particularly social restrictions, and the growth of non-compliance.
Appearing before the Parliamentary Health Committee, the Government’s Chief Scientific Officer, Sir Patrick Valiance said that keeping the pandemic toll to under 20,000 deaths would be “a good outcome” (17 March). But these and other failures have contributed to cumulative deaths numbering 42,000 and rising (October 2020), including 20,000 in care homes left to fend for themselves, one of the highest excess death rates due to coronavirus pro rata to population in the world, behind only Ecuador, Peru and (just) Italy (1).
The delayed Government lockdown of 16 March led in the following quarter to the sharpest contraction of the economy of any of the 37 OECD countries, and the forecast of a 10.1 per cent contraction for 2020 as a whole, well above that for the G20 (4.1 per cent) and the Eurozone (7.9 per cent) (2).
‘Failures of governance’ fall into different categories, with accordingly different implications for the reform of the country’s governing arrangements. Some are strategic, others operational; some are structural, the product of design faults in our decision-making institutions; others are human, the product of deficiencies in the country’s political leadership.
The persisting absence of a clear and coherent strategy: the government procrastinated over strategy when decisiveness was imperative in the face of conflicting models and advice from the epidemiologists. Initially the Government adopted a ‘mitigation’ strategy of ‘flattening’ the curve of rising infections by a programme of testing and isolating those with symptoms and shielding the vulnerable. But the limited available testing capacity was soon overwhelmed, which forced the Government to abandon community testing and switch to a ‘suppression’ strategy, requiring a national lockdown.
The hesitation over strategy led to four other major failures.
The delay to the lockdown: this was a policy failure of the core executive of ministers and their most senior advisers. The Government imposed the lockdown two weeks or more after much of Continental Europe, despite well-publicised reports from Lombardy in February of exponential increases in infections, overwhelmed hospitals and mounting deaths.
The Government had only half an eye on the ball (“we shall adopt the right measures at the right time”); Boris Johnson, distracted by delivering Brexit, and reluctant to grapple with the details of bad news, was absent from COBRA meetings.
The inadequate supply of PPE: this was an operational failure arising from bureaucratic inertia and amateurism. Despite warnings to the Department of Health and Social Care (DHSC) in June 2019 of low stocks, UK hospitals and care homes were beset with PPE shortages throughout March and April, resulting in higher than necessary absentee, infection and fatality rates of key medical and caring staff.
The DHSC had been slow to construct, pilot and test supply chains, and to recognise that gowns designed for influenza were inadequate for COVID-19 (3). By the time desperate NHS trusts looked abroad, global supply chains had dried up.
Frontline staff were promised PPE that didn’t materialise and issued with frequently changing guidelines. Number 10 scrambled through personal contacts to secure supplies with what turned out to be flawed contracts.
The offloading of untested elderly hospital patients to care homes: this appalling error was a product of long-term policy neglect in the form of chronic underfunding of social care since at least 2010, and of structural weakness in the central responsibility for social care provision, which is divided between the DHSC, local government, charitable and private providers. No agency considered it had overriding responsibility for the protection of the sector.
The NHS declared the highest level of emergency on 30 January, but there was no action plan for care homes until 15 April, by which time 25,000 elderly untested patients had been discharged by hospitals desperate to find beds for the swelling inflow of COVID-19 patients. PPE was in even shorter supply for the staff of under-resourced care homes, leading to high rates of self-isolation and absence from work. A parliamentary report concluded that care homes “were thrown to the wolves”.
The failure to set up a national TTI system: this was – and remains – a public service delivery fiasco, rooted in initial government ambivalence about the role of TTI in its overall strategy, a skills deficit in Whitehall and over-centralisation of implementation. On 16 March the Director General of the World Health Organisation declared that his central message was: “testing, testing, testing” (4). South Korea, Taiwan and Singapore had adopted a mass TTI programme and already appeared to have the virus under control. But four days earlier the Government abandoned general testing.
Public Health England was slow to get a national effort off the ground: a mass capacity TTI system, available locally on demand, with rapid processing times and reliable tracing of contacts needed to ensure timely isolation, proved a huge logistical challenge beyond PHE’s capability. A succession of capacity targets were set and usually missed. On 20 May Boris Johnson announced in Parliament that the UK would have a “world beating system” up and running by I June, but it did not materialise.
Moreover, capacity was irrelevant without efficient implementation on the ground. By September capacity had very significantly increased, but delivery was a shambles. People seeking appointments online were directed to testing stations hundreds of miles away; some testing stations were largely idle; tracers complained of being given no contacts to follow up; and the processing of test results was too slow – up to 48 hours – which defeated its purpose.
PHE over-relied on a small number of central laboratories for processing, and on a home-grown mobile phone app for contact tracing (of which the first prototype had to be abandoned). In retrospect, PHE should have taken advantage of the substantial unused processing capacity in university and private laboratories and should have mobilised local authorities, each of which has its own department of public health, with knowledge of the local community, for tracing contacts of those testing positive. Over eight months after infections began, Britain still lacks a national TTI system fit for the purpose of containing their spread.
The erosion of public trust and compliance: a test of good governance is its capacity to rely on the public’s compliance with emergency directives that disrupt their everyday lives and take away their normal freedoms. The Government began well: the unexpected lockdown, a drastic deprivation of people’s liberty and means of livelihood, was very widely supported and observed.
A palpable national solidarity, crystallised in support of the NHS, lasted until late May. It was sustained by the Government’s one undoubted success in the early stage of the pandemic – the rapid and efficient roll-out of bold schemes for furloughing workers who could not work from home, loans to businesses and adaptions to Universal Credit.
Solidarity then slowly frayed as lockdown measures were gradually eased. By late summer there were widespread breaches of compliance with the Government’s guidelines on social distancing, household mixing and masks.
There is no reliable measure of how compliance levels in the UK have compared with those abroad and nothing but impressions to suggest that public discipline has been stronger elsewhere. But by September self-reported levels of compliance were low. For example, a Kings College London survey of over 31,000 people living in the UK from March to August found that only II per cent of those in contact with someone who had tested positive went into quarantine and just 18 per cent of those who developed symptoms isolated themselves. By common observation enforcement in pubs, shops and public transport was patchy.
Acquiescence with social restrictions would very probably have drifted down irrespective of official exhortation and regulations, but numerous Government mistakes accelerated the drift. The critical failure was the absence of a clear and convincing strategy for balancing the protection of public health with sustaining the economy. The outcome was a set of regulations and appeals which taken together defied common sense: for example, the Government encouraged people to go out to pubs and restaurants, but avoid family get togethers; and throughout the lockdown, non-UK travellers from countries with high infection rates were free to disembark at airports without testing or restrictions and continue their journey (an automatic quarantine policy was introduced later by which point COVID-I9 levels in most countries abroad were much lower.) Apparent illogicality and inconsistency in the rules eroded the public’s confidence in them.
This was compounded by the Government’s carelessness with the public’s trust in both its competence and integrity. Government ministers and officials breached the social distancing in plain sight, and the Prime Minister’s Chief Adviser, Dominic Cummings, who broke the self-isolation rule, in spirit if not technically, escaped the sack, unlike other delinquent officials before him.
The message was that one could decide for oneself to be exempt from the rules. The blizzard of changes to the rules over the summer, compounded by different but varying restrictions for local lockdowns, left people both confused and sceptical that the rules in every detail were necessary.
Faith in the Government’s competence to manage the COVID-19 crisis was also undermined by a catalogue of policy reversals. Of these the most significant was the Education Minister’s reluctant reversal of his insistence that, in the absence of A level exams, teacher-assessed grades be adjusted by an OFQUAL algorithm despite warnings that it would produce bizarre and unjust results.
But the list includes: agreeing to the right of leave to remain for families of non-UK key workers who had died of COVID-19; the abandonment of the immigration health surcharge on immigrant doctors; the mid-June switch from resisting to insisting on the wearing of face masks on public transport, followed by a similar reversal in August for schools and shops; the abandonment of the commitment in June to give all primary school children four weeks of schooling; the switch from refusal to agreement to extend Free School Meals over the summer holidays; the cancelling of the home-grown NHSX tracing app for a new app involving Apple and Google; the launch in May of an ambitious antibody-testing programme (trailed by the prime minister as a potential “total game changer”), followed by its suspension in mid-July; and in late September the Prime Minister’s plea to people to work from home wherever possible, having appealed for the exact opposite three months earlier.
A few of these U-turns could be justified as reasonable adjustments to a changing situation; but most were concessions following intense
public and media pressure. The constant drip of policy shifts and reversals wore away public confidence in the Government’s grip, and the foundations for compliance with restrictions designed to manage the pandemic.
The COVID-19 pandemic has tested the British State’s capabilities and the Government’s competence. Both get relatively low marks. What are the lessons to be learned for next time? A brief list follows:
1. Do not plan future wars with the battleplans of the last. PHE was geared up for an influenza epidemic similar to SARS in 2003 and MERS in 2015 but Covid-19 proved far more infectious, unpredictable and lethal.
2. Do not delay the action plans of risk assessments.
3. Understand the limits of scientific advice. There is always some uncertainty and therefore rarely full consensus. Social scientists (e.g. of public health) should be heard alongside modellers (epidemiologists) and biomedicals (virologists). All should be on tap, not on top. Elected politicians must always choose between conflicting scientific advice.
4. Develop, at speed, a clear and coherent strategy, apply it across all policy sectors, and sell it to decision makers and public alike. This is the ultimate test of good government.
5. Recognise the limits to the centre’s capacity to design and deliver public services. Incorporate from the start local government and other local agencies in delivery of services on the ground.
6. An old lesson, still not learned: develop Whitehall’s project programme skills, especially in IT and logistics, on a much larger and deeper scale, or at least the skills of an intelligent client if outsourcing complex projects.
7. Another old lesson, not yet cracked: improve both horizontal and vertical coordination of responsibility in policy sectors that cut across departments, e.g. social care.
8. Nurture public trust, which will be needed for compliance. Adopt a communications strategy that levels with the public. Under-promise and over-deliver, not the other way round.
Public policy failures rarely have a single or common cause, as this eclectic list reveals. There are lessons for the strengthening of the country’s administrative apparatus and decision-making structures. But the quality of governance ultimately rests with the quality of governors, which cannot be legislated for.
Professor Sir Ivor Crewe, was until 2020 the Master of University College, Oxford and President of the Academy of Social Sciences. He was previously Vice-Chancellor of the University of Essex and also a Professor in the Department of Government at Essex. In 2013, he co-authored The Blunders of our Governments.
References:
(1) FT Visual a Data Journalism team, ‘Coronavirus Tracked: The Latest Figures as Countries Fight Covid-I9 Resurgence’, The Financial Times, I October 2020
(2) Building Confidence amid an Uncertain Recovery: OECD Economic Outlook, Interim Report September 2020 (OECD Economic Outlook, 2020)
(3) Camilla Hodgson, ‘UK Had No Stocks of Protective Gowns When Coronavirus Struck’, Financial Times, 28 May 2020
(4) WHO Director-General’s Opening Remarks at the Media Briefing on COVID-I9 -16 March 2020′, Web Page, World Health Organisation, 16 March 2020.
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