By Paul Joyce
I have watched the spread of the Coronavirus in the UK with much the same emotions and fears as everybody else. I have mainly been worried for myself and for my family and friends – but actually also for everybody else.
As the weeks have passed, I have also been developing a growing sense of unease from a very different point of view. I teach a university course on strategic management for public administration students, and I have found myself wondering, increasingly, about the government’s strategic management of the pandemic.
Speaking as an academic, what I would hope for from government is this,
First, that there would be real clarity in communications to the public about the top strategic priorities of the UK government in relation to the pandemic.
Second, I would expect there to be a pandemic strategy document setting out both strategic goals and a contingency plan (or a framework for a plan) that covers capacity and public governance considerations.
Third, I would expect appropriate “tools” to be used to connect means and ends in designing and delivering the strategy and to address the issue of risks for the public.
Finally, I would expect strategic management of a pandemic to be made more effective by a system of monitoring and evaluation to enable government to learn lessons while delivering its strategy and consequently to make refinements and adjustments.
So why do I feel uneasy?
My first reason has to be the pandemic mortality rate for the UK. It may not be the worst, but it is bad. This alone prompts me to ask, “What has gone wrong?”
My second is that I have read the 2011 Department for Health’s UK Influenza Pandemic Preparedness Strategy. This strategy built upon, but differed from, the 2005 UK Influenza Pandemic Contingency Plan produced by the previous Government. There is not space here to go into details about the 2011 strategy, but it contained this statement that worried me. “It will not be possible to halt the spread of a new pandemic influenza virus, and it would be a waste of public health resources and capacity to attempt to do so” (page 28, UK Influenza Pandemic Preparedness Strategy, Department of Health 2011).
It’s true that Deidre Hine’s evaluation of the Swine Flu pandemic of 2009/10 (published by the Cabinet Office in 2010), stated that containment activities had taken longer and used up more resources than expected. But she also was quite positive about how the Brown government of the day had managed the pandemic and mentioned that many people believed that the steps taken did have some impact in slowing the initial spread.
So, surely her remarks required following up by a systematic assessment of costs and benefits? If this wasn’t done, I would query if the austerity mind-set of that time biased the content and planning assumptions of the 2011 strategy.
My third reason for concern is the slogan used for the last few weeks to drill into the minds of the British public that they should comply with the lockdown. The slogan is “Stay at Home, Protect the NHS, Save Lives”. I understand the formal rationale for this slogan: more lives can be saved if the transmission rate in the community is reduced so that the number of people needing intensive care and ventilators can be kept within the current NHS capacity to deliver. This is logical. But it jarred with me. At times, the ministerial emphasis given to “protect the NHS” seems tantamount to making the NHS an end rather than a means.
Of course, the sense we make of this slogan depends on context. Would I have felt quite so uneasy if there had not been rumours about the government’s hesitancy to act, the limited use of testing and tracing in the community, and the ill-preparedness of the NHS? These rumours included concerns that lessons had not been learnt from the “Operation Cygnus” exercise in October 2016, which one expert suggested had showed that our hospitals were not prepared to deal with a pandemic. There have been other rumours that the government and its advisers were in fact pursuing a strategy of exiting from the pandemic by developing the “herd immunity” of the British public. Presumably this exit strategy might mean we did not need to hold on until a vaccine was developed. The counter argument to this rumour was that herd immunity was not a target of government action but rather a desirable consequence of government strategy. Obviously, the main advantage of an early exit from the pandemic on the basis of herd immunity would be a quicker restoration of the entire economy. Then again, a public policy of accepting that many people would need to get infected to create herd immunity implied a risk calculation that a high death rate among senior citizens might occur if “shielding” them failed. Leading officials in the World Health Organisation in a March press conference expressed the view that herd immunity calculations were brutal and that not taking the death of senior citizens seriously is an aspect of moral decay.
The question however remains, “How have we actually struck a balance between the strategic goals of minimising the loss of human life and protecting the economy?”
My final reason for concern relates to the way in which government strategic decision making is presented as being determined by “science”. My unease on this point was strongly excited by recent remarks at a Downing Street briefing, given in response to a question from a journalist. I thought I detected either defensiveness or excessive pride in the UK’s prowess in using modelling of pandemics.
ITV’s Tom Clarke asked if it was now time for the government to admit that thousands of UK deaths had been, and would be, caused by a failure of the UK to test more people more rapidly. Stephen Powis, National Medical Director at NHS England, answered that that it was difficult, at this stage, to know if Germany’s lower death rate was a result of its greater use of testing. He said this was because of the presence of a range of factors. He went on, “I think the Chief Medical Officer [of the UK] was also making clear that it is important that all countries learn from each other. And I’ve no doubt that other countries will want to learn from our experience and some of the things that we have done in the United Kingdom. For instance, the work on modelling and predicting what the epidemic might do.”
If Stephen Powis is right in stressing that at this stage we cannot know if large-scale testing in Germany has caused it to have a much lower mortality rate than the UK, how can we yet know that UK modelling (“science”) as a tool for making predictions has been a UK success or strength during our response to the pandemic?
Is this UK modelling “science”? Models used to predict the course of the pandemic in the UK may have used empirical evidence, but they were being used to predict the future. And as we have been told repeatedly, we must wait and see when the UK peak of the pandemic will come because what actually happens depends on what the British public chooses to do.
So, predicting the future course of the pandemic in the UK both implies making assumptions about what government will do and how the public reacts. These models, for purposes of prediction, might be defined as being partially public policy models (what government could do), but certainly not pure social science models, which could be defined as created to explain past behaviour on the basis of facts.
The question is therefore what policy assumptions may have shaped the slow and hesitant response of the UK Government to the spread of the virus? Was their early slowness actually caused by government leaders’ desire to protect the economy in this first year of having left the EU? Did the recent shift to a “stay at home” policy reflect a change of direction to saving lives or was it, as the government claimed, “the right decision at the right time”? And if it was the right decision at the right time, was it a part of a mitigation strategy to increase the chances of the NHS not being overwhelmed by the numbers of people infected with the virus?
The evidence is not currently available to properly judge all of these things and the time for a comprehensive objective evaluation of what has happened is not now. But now is the time for us to get clearer about what is actually happening in strategic management terms and what the consequences are – and seeing them clearly – so that there can be constructive criticism now, which is essential in a free and democratic society in which public governance is based on consent.