Lessons from the COVID Emergency – 14

The Covid-19 Inquiry:  If not now, when?
by Una O’ Brien

If I were working in government right now, I could imagine advising that any inquiry into Covid-19 should be left until next year, maybe even later.    Normal working patterns are in disarray and there are difficult days ahead in which to steer public services, the economy and people’s lives back to some sort of normality.      In such circumstances the additional burden of an independent inquiry looms large, making demands on weary public servants and ministers, asking for documents, statements and evidence at public hearings.   In any case, my advice might go, how can there be an inquiry into something that is still ongoing?

From outside, however, things look very different. Out here, arguments continue to mount in favour of an effective formal, investigation into the way the pandemic has been managed by the UK government. Early lessons really do matter, quite simply to help save lives next time round.  Who knows what the virus could throw at us in the coming months?   But more than that, an independent inquiry offers a unique form of accountability that is difficult to match.   And with enhanced accountability comes greater trust between government and people, something we know to be sorely in need of repair.

But what about those practical objections? In this blog, I focus on one in particular – that any terms of reference would be so unwieldy and wide ranging as to make the task un-doable.   One possible approach, since that is where the current urgency lies, would be to conduct the inquiry in phases, reserving the wider systemic issues for later and focussing now on the period prior to and during the first wave of the pandemic. Drafting terms of reference using this approach is perfectly possible: here’s how it could be done:

Covid-19 Inquiry Phase One:  Draft Terms of Reference
To examine the circumstances surrounding the initial emergence in the United Kingdom of the Covid-19 virus and the response to the first wave of the pandemic, including:

(1)  The scope and adequacy of preparations for a virus pandemic, at national, devolved and local levels.
(2)  The means by which the Covid-19 virus initially arrived and spread in the UK
(3)  How and when knowledge and understanding of Covid-19 and its likely impact on the UK was initially comprehended at national government level and what actions were taken in January and February 2020
(4)  The structure, contribution and role of UK government convened scientific advisory committees and the relationship between their advice and ministerial decision making prior to, during and throughout the period up to the end of June 2020
(5) The adequacy of the strategy, timing, speed and implementation of the UK-wide government and the devolved government responses up to the end of June 2020
(6) A definitive account for the UK up to the end of June 2020 of how many people, by age, gender, ethnic background and occupation, contracted Covid-19 and the known outcomes for those people. To the extent discernible, how many people contracted the infection in institutional locations such as care homes and hospitals, and as well as in other workplaces
(7) To draw lessons and make recommendations as to the action required to reduce the impact of any future pandemic.

What is the relationship between such concise terms of reference and the many specific and important questions that we would expect the inquiry to address?   While any inquiry worth its salt would, within weeks, publish its own ‘issues list’ or ‘lines of enquiry’,  it could help if, ahead of that,  the terms of reference indicated which were the most important questions and issues under each theme.  Here are  my suggestions as to what could be included:

 (1)The scope and adequacy of preparations for a virus pandemic, at national, devolved and local levels.

This would encompass preparations across all of government, the NHS and local government including crucially, social care. Did the government apply lessons from Exercise Cygnus in 2016?  Were stockpiles of PPE sufficient and up to date?  How much did it matter that preparations were focused on pandemic influenza as opposed to what we are experiencing, a SARS-like infection?

(2) The means by which the Covid-19 virus initially arrived and spread in the UK

Here we could expect as clear as possible an account of the emergence and transmission of the Covid-19 virus, in the context of events in China and elsewhere from the turn of the year.  We have so much more to learn about how the virus is transmitted and what types of effective action are needed to limit its spread.

(3) How and when knowledge and understanding of the Covid-19 virus and its likely impact on the UK was initially understood at national government level and what actions were taken in January and February 2020

This would call for a chronology and forensic analysis of activity from the earliest point in January 2020 up to the lockdown. What major mitigating actions were implemented in those early weeks? What interactions did the UK  government have with the WHO and other countries and was the knowledge gained acted on? What decisions were made about ports of entry?  Why was the quarantine system initially introduced and then abandoned?

(4) The structure, contribution and role of UK government convened scientific advisory committees and the relationship between their advice and ministerial decision making prior to, during and throughout the period up to the end of June 2020

Scientific advice has been at the core of the national response; a transparent account of what the system is and how it has performed is sorely needed.  What range of scientific disciplines have contributed to the advice and have all the necessary disciplines, to the highest level of expertise, been included?   What have been the significant points of disagreement and have those disagreements been visible to ministers?

(5) The adequacy of the strategy, timing, speed and implementation of the UK-wide and the devolved government responses up to the end of June 2020

Herculean effort, lightning-speed preparations and hard work can be acknowledged alongside mistakes, mis-steps and straightforward omissions to address the simple question, ‘Could we have done better’?  How did co-ordination of policy implementation take place between the four nations, between different departments of state and arm’s length bodies?  How well did PHE and other public health agencies contribute and perform? What role did business, universities and third sector organisations play?  How effectively were public health messages communicated?

(6) A definitive account for the UK, up to the end of June 2020, of how many people, by age, gender, ethnic background and occupation, contracted Covid-19 and the known outcomes for those people. To the extent discernible, how many people contracted the infection in institutional locations such as care homes and hospitals, and as well as in other workplaces

Large scale analysis by the ONS and academics is already underway. A formal inquiry could both draw on and influence this work ensuring that a full account provides an explanation on the critical questions of excess deaths,  why outcomes for people from black and minority ethnic communities have been more severe and to what extent infections in hospitals and in care homes  occurred due to a lack of preparation, infection control and PPE.

(7) And to make recommendations as to the action required to reduce the impact of any future pandemic

Lessons and recommendations would be obvious outputs.  Yet we shouldn’t have to wait for a report to know them: an innovative inquiry would communicate key lessons at points along the way, and not ‘save’ them all for the final report.    The same goes for key documents and statements which could be published at stages throughout the course of the inquiry.   An inquisitorial, no-blame inquiry, focussed on the facts and the lessons, should be able to do its job with maximum transparency.

In May the UK government  backed a call at the World Health Assembly for ‘a stepwise process of impartial, independent and comprehensive evaluation’ by the WHO ‘to review experience gained and lessons learned’.   Since that is the case internationally, what better time than this summer, as the first serious phase of the pandemic recedes, for the UK government to do the same for its citizens and launch an impartial, independent and comprehensive inquiry here? If not now, when?

Una O’Brien is a co-author of the recent public inquiry report into the ‘cash for ash’ RHI scandal in Northern Ireland  and was Secretary to the Kennedy/Bristol public inquiry into children’s heart surgery and the NHS (2001).  Between 2010 and 2016 she was Permanent Secretary at the Department of Health.