Third Report - Coronavirus: lessons learned to date

Select Committee

Science, Innovation and Technology Committee HC 92 12 October 2021

Report Status Government responded

Conclusions & Recommendations 200 items (10 recs)

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Recommendations

10 results

66

The Government should ensure comprehensive plans are made for future risks and emergencies.

Recommendation

The Government should ensure comprehensive plans are made for future risks and emergencies. The UK should aim to be a world leader in co-ordinating international resilience planning, including reform of the World Health Organisation to ensure that it is able … Read more

Department for Science, Innovation and Technology

127

Dominic Cummings told our inquiry that Downing Street held a meeting on 20 September 2020...

Recommendation

Dominic Cummings told our inquiry that Downing Street held a meeting on 20 September 2020 for the Prime Minister to hear both sides of the argument. He explained that Professor John Edmunds put forward the view that the Government should … Read more

Department for Science, Innovation and Technology

161

In a pandemic, the scientific advice from the SAGE co-chairs to the Government should be...

Recommendation

In a pandemic, the scientific advice from the SAGE co-chairs to the Government should be published within 24 hours of it being given, or the policy being decided, whichever is the later, to ensure the opportunity for rapid scientific challenge … Read more

Department for Science, Innovation and Technology

200

The failure of the test and trace system to rise to meet even the most...

Recommendation

The failure of the test and trace system to rise to meet even the most predictable of demands in Autumn 2020, especially given many weeks to prepare, suggests that lessons that were learnable during the pandemic were not applied. An … Read more

Department for Science, Innovation and Technology

9

Para 66

The Government should ensure comprehensive plans are made for future risks and emergencies.

Recommendation

The Government should ensure comprehensive plans are made for future risks and emergencies. The UK should aim to be a world leader in co-ordinating international resilience planning, including reform of the World Health Organisation to ensure that it is able … Read more

Department for Science, Innovation and Technology

27

Para 161

In a pandemic, the scientific advice from the SAGE co-chairs to the Government should be...

Recommendation

In a pandemic, the scientific advice from the SAGE co-chairs to the Government should be published within 24 hours of it being given, or the policy being decided, whichever is the later, to ensure the opportunity for rapid scientific challenge … Read more

Department for Science, Innovation and Technology

38

Para 241

Scientific excellence is not enough in test and trace programmes: the UK must develop greater...

Recommendation

Scientific excellence is not enough in test and trace programmes: the UK must develop greater operational competence in deployment. In particular, the Government must ensure that both the new UK Health Security Agency and local authorities have the capability and … Read more

Department for Science, Innovation and Technology

40

Para 243

Those responsible for future test and trace programmes should establish a culture and processes to...

Recommendation

Those responsible for future test and trace programmes should establish a culture and processes to learn rapidly from errors and to act to prevent them being repeated.

Department for Science, Innovation and Technology

51

The Government should review the provision of infection prevention and control measures, including infection prevention...

Recommendation

The Government should review the provision of infection prevention and control measures, including infection prevention and control nurses, to social care and ensure that social care providers, particularly care homes, are able to conduct regular pandemic preparedness drills. The Government … Read more

Department for Science, Innovation and Technology

57

Para 335

The Government should ensure its ‘levelling up’ agenda includes specific policies to reduce health inequalities,...

Recommendation

The Government should ensure its ‘levelling up’ agenda includes specific policies to reduce health inequalities, with a particular focus on ensuring that certain groups, including people from Black, Asian and minority ethnic backgrounds, do not continue to face unequal health … Read more

Department for Science, Innovation and Technology

Conclusions (190) Observations and findings — click to expand

58 Conclusion

The UK has established procedures and structures to prepare for the nation’s major future risks, including a National Risk Register, the Civil Contingencies Secretariat and the Scientific Advisory Group for Emergencies (SAGE). However, the anticipated future risk of pandemic disease focused too closely on influenza rather than diseases like SARS …

59 Conclusion

Previous exercises to test the national response capability, namely Exercises Cygnus and Winter Willow, did not squarely address a disease with the characteristics of covid-19. Nevertheless, some useful lessons were learned and applied, such as the drafting of legislative measures that might be needed. 93 Healthcare Infection Society (CLL0071) 94 …

60 Conclusion

The operation of COBR was not well-suited to the modern demands of a pandemic response. It is especially concerning that its culture of confidentiality was considered by some to be so unreliable that alternative meetings were arranged that could command greater confidentiality among participants.

61 Conclusion

The Civil Contingencies Secretariat did not have adequate resources to maintain a substantial standing capability to survey the development of potential threats, and it had a limited reach into the range of Government departments required to respond to a pandemic. The experience has been that this investment in resilience is …

62 Conclusion

Protocols to share data between public bodies involved in the response were too slow to establish and to become functional. This was especially true in the data flows from national to local government.

63 Conclusion

The NHS responded quickly and strongly to the demands of the pandemic, but compared to other health systems it “runs hot”—with little spare capacity built in to cope with sudden and unexpected surges of demand such as in a pandemic. Recommendations and lessons learned

64 Conclusion

A greater diversity of expertise and challenge—including from practitioners from other countries and a wider range of disciplines—should be included in the framing of the National Risk Register and the plans that emanate from it. Plans for the future should include a substantial and systematic method of learning from international …

65 Conclusion

A standing capability should be established in Government, or reporting to it, to scan the horizon for future threats, with adequate resource and counting on specialists with an independence from short-term political and administrative pressures.

67 Conclusion

The resourcing and capabilities of the Civil Contingencies Secretariat should be improved. The Civil Contingencies Secretariat should be empowered to ‘stress test’ plans and to ensure that Departments are able to carry out a contingency plan if required. The details and results of these stress tests should be included in …

68 Conclusion

Arrangements should be established and tested to allow immediate flows of data between bodies relevant to an emergency response with a mechanism to resolve immediately and decisively any disputes.

69 Conclusion

The Armed Forces should have a more central and standing role in preparing for and responding to emergencies like pandemics, given the depth of capability and experience they have in planning, logistics and rapid mobilisation. The Civil Contingencies Secretariat should work with the Armed Forces to improve operational expertise in …

70 Conclusion

The Government and the NHS should consider establishing a volunteer reserve database so that volunteers who have had appropriate checks can be rapidly called up and deployed in an emergency rather than needing to begin from scratch.

71 Conclusion

The experience of the demands placed on the NHS during the covid-19 pandemic should lead to a more explicit, and monitored, surge capacity being part of the long term organisation and funding of the NHS.

72 Conclusion

The NHS should develop and publish new protocols for infection prevention and control in pandemics covering staffing, bed capacity and physical infrastructure. In developing these protocols the NHS should consider the importance of maintaining access for people accompanying some patients such as advocates for people with learning disabilities and birthing …

73 Conclusion

Comprehensive analysis should be carried out to assess the safety of running the NHS with the limited latent capacity that it currently has, particularly in Intensive Care Units, critical care units and high dependency units.

74 Conclusion

Building on the experience of staff working more flexibly during the pandemic and to enable more flexible staffing in the NHS, NHS England and Health Education England should develop proposals to better enable NHS staff to change clinical specialty mid-career and train in sub-specialties. 32 Coronavirus: lessons learned to date …

75 Conclusion

Much of the impact of covid-19 during the first wave was determined by decisions made during the early weeks of the pandemic, between January and late March 2020. The seriousness of the threat to the UK was recognised in January when the Government’s Scientific Advisory Group for Emergencies—SAGE—was convened and …

76 Conclusion

The veil of ignorance through which the UK viewed the initial weeks of the pandemic was partly self-inflicted. As we examine in depth in Chapter 4, the UK failed to turn an early lead in developing a test for covid in January 2020 into a testing operation that was adequate …

77 Conclusion

The initial UK policy was to take a gradual and incremental approach to introducing non-pharmaceutical interventions. A comprehensive lockdown was not ordered until 23 March 2020—two months after SAGE first met to consider the national response to covid- 19.99 This slow and gradualist approach was not inadvertent, nor did it …

78 Conclusion

As a result, decisions on lockdowns and social distancing during the early weeks of the pandemic—and the advice that led to them—rank as one of the most important public health failures the United Kingdom has ever experienced. This happened despite the UK 97 GOV.UK, ‘Precautionary SAGE 1 minutes: Coronavirus (COVID-19) …

79 Conclusion

There has been considerable debate as to whether the early policy of the Government was one of seeking to achieve so-called “herd-immunity”. The US Centres for Disease Control and Prevention defines community immunity/herd immunity as: A situation in which a sufficient proportion of a population is immune to an infectious …

80 Conclusion

Non-pharmaceutical interventions such as lockdowns, and the testing and isolation of covid cases and their contacts, are tools of temporary application. Once they are lifted, there is nothing to stop transmission resuming. When Sir Patrick Vallance said at a Government press conference on 12 March 2020 “it’s not possible to …

81 Conclusion

From our evidence this appears to have led to a policy approach of fatalism about the prospects for covid in the community: seeking to manage, but not suppress, infection. This amounted in practice to accepting that herd immunity by infection was the inevitable outcome, given that the United Kingdom had …

82 Conclusion

So in the absence of a vaccine or an effective treatment being available at first, the UK faced a choice of doing everything possible to halt the virus, or seeking instead to moderate the pace of its spread. The UK chose the latter.106

83 Conclusion

Even as late as 12 March 2020, as noted in paragraph 80, Sir Patrick Vallance, Government Chief Scientific Adviser, told a Government press conference that it was not possible to stop everyone being infected, and nor was that a desirable objective. The following day in a media interview Sir Patrick …

84 Conclusion

The Government’s action plan of 3 March indicated that there was no intention to bring in a lockdown as strict as had been implemented in some other parts of the world. The action plan, under the heading ‘the Delay phase - next steps’ said: Action that would be considered could …

85 Conclusion

At its meeting of 5 March 2020, SAGE reconfirmed an explicitly gradual approach: There is epidemiological and modelling data to support implementation– within 1 to 2 weeks–of individual home isolation (symptomatic individuals to stay at home for 14 days) and whole family isolation (fellow household members of symptomatic individuals to …

86 Conclusion

On 9 March 2020, SAGE set out a number of non-pharmaceutical interventions that could in due course be introduced by the Government. SAGE advised that “measures relating to individual and household isolation will likely need to be enacted within the next two weeks to be fully effective, and those concerning …

87 Conclusion

It is striking, looking back, that it was accepted that the level of covid-19 infection in the UK could be controlled by turning on particular non-pharmaceutical interventions at particular times. Indeed such was the belief in this ability to calibrate closely the response that a forward programme of interventions was …

88 Conclusion

This was not the only way to proceed, and indeed the UK was an outlier internationally in the gradualist approach that was being taken before late March.120 Countries in East Asia were the first to experience covid-19. Their response was a much more rapid and muscular imposition of social distancing …

89 Conclusion

On 24 February the World Health Organisation published the report of its international mission to Wuhan, and advised that countries should: (1) Immediately activate the highest level of national Response Management protocols to ensure the all-of-government and all-of-society approach needed to contain COVID-19 with non-pharmaceutical public health measures; (2) Prioritize …

90 Conclusion

In evidence to the Science and Technology Committee on 25 March 2020, the Editor of The Lancet, Dr Richard Horton, said that his journal had published articles on 24, 29 and 31 January with an analysis of the situation in China.124 He told the Committee: Those papers were truly alarming …

91 Conclusion

The UK policy was to change abruptly. During the days before 23 March, multiple people within the Government and its advisers experienced simultaneous epiphanies that the course the UK was following was wrong, possibly catastrophically so. In his evidence to our inquiry Dominic Cummings told us: On Friday the 13th …

92 Conclusion

In evidence to the Science and Technology Committee in July 2020, Sir Patrick Vallance, said that SAGE advised the Government to implement the remainder of the menu of options for social distancing measures—in essence a full lockdown—on 16 or 18 March 2020: When the SAGE sub-group on modelling, SPI-M, saw …

93 Conclusion

It seems astonishing looking back that—despite the documented experiences of other countries; despite the then Secretary of State referring to data with a Reasonable Worst Case Scenario of 820,000 deaths;138 despite the raw mathematics of a virus which, if it affected two-thirds of the adult population and if one percent …

94 Conclusion

The UK did not impose blanket or rigorous border controls at the onset of the covid-19 pandemic as compared to other countries, particularly in East and South East Asia.140 Instead, the UK implemented light-touch border controls only on countries and regions where there was a recorded high incidence rate. While …

95 Conclusion

By contrast, other countries implemented more rigorous border controls which were more effective at suppressing the virus and preventing the need for long and repeated lockdowns. However, even though it is not straightforward to make direct comparisons between countries, and it is yet to be seen how countries like New …

96 Conclusion

In the paragraphs that follow we consider some of the potential explanations of why the initial decision-making on lockdowns was wrong, and what lessons can be drawn for the future from this. Should the Government have unilaterally taken a precautionary view in the first weeks, despite the SAGE advice?

97 Conclusion

The UK’s structure of scientific advice in emergencies, in which a group is formed of relevant experts (SAGE) to advise the Government is a prominent feature of our arrangements—much more so than in many other countries. Initially, participation in SAGE was not disclosed, nor the papers on which its advice …

98 Conclusion

SAGE provides advice to Ministers, whose responsibility it is to make policy decisions. However, witnesses to our Committees confirmed that during the early months of the pandemic the Government acted on the scientific advice it was given. Sir Patrick Vallance, for example, told the Science and Technology Committee on 25 …

99 Conclusion

We accept that it is difficult for Ministers to go against a scientific consensus among the body set up to provide scientific advice during a national emergency. We also understand the reluctance to introduce measures with significant negative economic impact. But the 141 Imperial College London, ‘COVID-19 transmission chains in …

100 Conclusion

Several witnesses to our inquiry, reflecting on the early weeks of the pandemic, were rueful that they did not sufficiently question and challenge the advice they were being given. We heard that challenging an established scientific consensus was difficult. Dominic Cummings told us: It was clear through all the meetings …

101 Conclusion

The then Secretary of State, Matt Hancock MP, made the same point regarding the difficulty of challenging a scientific consensus.148 On 28 January 2020, SAGE said that testing asymptomatic individuals would “not be useful”.149 However, at the same meeting, SAGE went on to say that there was “limited evidence of …

102 Conclusion

We accept that it is difficult to challenge a widely held scientific consensus. But accountability in a democracy depends on elected decision-makers taking advice, but examining, questioning and challenging it before making their own decisions. We find it surprising that the fatalistic assumptions behind the initial scientific advice were not …

103 Conclusion

In his evidence to the Science and Technology Committee during the early weeks of the pandemic, on 25 March, the Editor of the Lancet expressed concern that mathematical modelling was playing too influential a role in UK scientific advice.157 The prominence of modelling and projections was, and still remains, an …

104 Conclusion

Evidence to the Science and Technology Committee from other academic disciplines included scepticism of the weight being placed on mathematical models during the pandemic. For example Professor Sir John Kay, Economist and Fellow in Economics, St 152 Correspondence from Rt Hon Greg Clark and Rt Hon Jeremy Hunt to Matt …

105 Conclusion

Sir John also highlighted concerns about how different academic disciplines did not collaborate sufficiently on models.164 Professor James Poterba, Mitsui Professor of Economics, Massachusetts Institute of Technology, explained to the Science and Technology Committee that the consequence of this was that some costs were not factored into models earlier in …

106 Conclusion

Professor Chris Whitty noted that he preferred advice to be given on the basis of observed data, telling the Science and Technology Committee in November 2020: “It is important to say that a lot of the advice that I have given is not based on significant forward modelling. It is …

107 Conclusion

Yet despite this, throughout the pandemic, detailed modelled projections have assumed a great prominence and have evidently had great influence on Government decisions. Indeed, the publication of the Imperial study of 16 March, is often cited as one of the main triggers for the abandonment of the initial policy of …

108 Conclusion

Another potential reason for the late lockdown was the behavioural advice that was being tendered to the Government. Behavioural advice is tendered to the Government through SAGE’s sub-group, the Scientific Pandemic Insights Group on Behaviours (SPI- B).168 SPI-B’s first publicly known input into SAGE was on 25 February 2020 on …

109 Conclusion

The initial action plan did not consider the possibility of ceasing all non-essential contact. Dominic Cummings told us that the idea of behavioural fatigue was a part of “false groupthink”: One of the critical things that was completely wrong in the whole official thinking in SAGE and in the Department …

110 Conclusion

It transpired that the UK public were very compliant with the eventual lockdown measures.175 Professor Chris Whitty also said in November 2020: Across the board, my reflection is that the great majority of people—and this is reflected in all the polling and a variety of other things—both intend to stick …

111 Conclusion

The restrictions eventually imposed on the UK public because of the pandemic were unprecedented. Even in wartime there had been no equivalent of the order to make it a criminal offence for people to meet each other and to remain in their homes other than for specified reasons. In advance, …

112 Conclusion

We have referred to early evidence from Dr Richard Horton, the Editor of the Lancet, who was concerned that SAGE in its early months was taking insufficient account of international perspectives. At the time he gave his evidence, Dr Horton, like the rest of the public, was not aware of …

113 Conclusion

It is a characteristic of the best UK scientific institutions, and the people that work in them, that much of their research involves extensive international collaboration. However, for a virus that has affected every country in the world and which was experienced first by other countries, it is also right …

114 Conclusion

Dr Horton expressed concerns about the evidence base that SAGE in its early meetings drew upon. Referring to scientists in East Asia, Dr Horton told the Science and Technology Committee: If I had been Chair of SAGE, I would have wanted to go to those scientists on the frontline saying, …

115 Conclusion

Although introduced several weeks after it should have been, the national lockdown brought in on 23 March succeeded in reducing the incidence of covid across the country, so that from May 2020 national restrictions were eased. However, tougher restrictions were maintained in areas where infections were higher. For example, the …

116 Conclusion

The Government sought to agree with local leaders the package of restrictions that would apply in particular areas. However, the consequence of this approach led to political differences between national government and some local leaders as to what measures were appropriate for their area—most prominently, the Greater Manchester Mayor, Andy …

117 Conclusion

By mid-September 2020, case rates were rising across the country, but there were significant local differences. For example, on 30 September, the incidence of covid ranged from 607 per 100,000 population per week in East Sussex, to 4,318 in Knowsley.182 To 177 GOV.UK, ‘List of participants of SAGE and related …

118 Conclusion

As we discuss in Chapter 4, there had been hopes that by Autumn 2020 an effective test, trace and isolate system—promised to be “world-beating”—would allow covid levels to be contained without recourse to extensive lockdown restrictions. Indeed the business case that the Test and Trace organisation put forward for Treasury …

119 Conclusion

The experience of the tiered system during the autumn was, however, unsatisfactory. In the absence of effective contact tracing, the regional restrictions proved not to be anywhere near watertight enough to prevent infections spreading, compounded by delays in getting test results. Professor John Edmunds, Professor of Infectious Disease Epidemiology and …

120 Conclusion

Professor Dame Angela McLean, Chief Scientific Adviser to the Ministry of Defence and a participant of SAGE, told the Science and Technology Committee in February 2021 that the tier system waited until prevalence was high before any action was taken, implying this was a flaw with the tier system: What …

121 Conclusion

Another problem with the tiered restrictions that were implemented during the autumn of 2020 was that it was not fully clear what criteria would cause a particular area to be placed in a given tier, nor what would be required for it to exit a particular tier. At times, these …

122 Conclusion

There has also been a lack of transparency over the scientific case for particular interventions. After the initial, broad lockdown had been lifted specific prohibitions were introduced in later months. Such restrictions were typically justified by Ministers as 186 Q164 187 Oral evidence taken before the Science and Technology Committee …

123 Conclusion

Scientific advice was cited in justification for increasingly fine-grained restrictions— with which some of the Government’s scientific advisers were often visibly uncomfortable. When Sir Patrick Vallance, the Government Chief Scientific Adviser, was asked on 3 November why children’s outdoor sport was banned, despite by then widespread evidence that outdoor transmission …

124 Conclusion

The two months between September 2020 and 31 October 2020 were an unsatisfactory period in which the comparative simplicity of the rules in place from the evening of 23 March onwards were replaced by a complex, inconsistent, shifting and scientifically ambiguous set of detailed restrictions. The rules had previously been …

125 Conclusion

Throughout September and October 2020, case numbers and hospitalisations continued to rise nationwide. As the virus started to spread and a second wave appeared to have started, SAGE advised on 21 September 2020 that a two week ‘circuit breaker’, a short and sharp lockdown, could return incidence to manageable levels.193 …

126 Conclusion

In evidence to the Science and Technology Committee in November 2020, Sir Patrick Vallance added that the intention of the circuit breaker was to enable the test and trace system—which in September had once again been found to be inadequate—to be more effective: The advice in September was about a …

128 Conclusion

It is impossible to know whether a circuit breaker would have had a material effect in preventing a second lockdown, given that such an approach was pursued in Wales, which still ended up having further restrictions in December 2020. But it seems that Ministers were mistaken in the weeks after …

129 Conclusion

On 31 October 2020, the Prime Minister announced tougher nationwide restrictions in England—the second lockdown.200 The UK public were once again told to “stay at 194 GOV.UK, SAGE 59, 24 September 2020 195 Oral evidence taken before the Science and Technology Committee on 3 November 2020, HC (2019–21) 136, Q1505 …

130 Conclusion

The circumstances of the lockdown announced on 31 October were controversial. A Downing Street press conference had been hastily convened on the Saturday evening following leak to newspapers of the Government’s likely intention to bring in a further lockdown.

131 Conclusion

At the press conference, modelling projections were presented which warned of a risk to the ability of the NHS to cope with likely hospital admissions unless the proposed measures were taken. Sir Patrick Vallance in evidence to the Science and Technology Committee on 3 November said: You would expect the …

132 Conclusion

However, it emerged during the following days that the modelling that was presented at the press conference was based on data that had been superseded by more up-to-date information. It also emerged that the forecasts did not include the impact of the regional restrictions that had been brought in on …

133 Conclusion

Whilst it is clear the first lockdown was called too late, it is not however possible to make such a clear cut judgement about the second lockdown from 31 October for two reasons. First, since the advice was taken and lockdown measures were introduced, the counterfactual—what would have happened to …

134 Conclusion

Following genomic sequencing, PHE found that the Alpha variant first appeared in Kent in September 2020 and rapidly became the dominant variant in Kent, and subsequently, the rest of England.207 The new variant was first brought to the attention of the Government on 11 December 2020.208 On 18 December, the …

135 Conclusion

Leading virologists who gave evidence to the Science and Technology Committee on 23 December said that the Government had acted quickly in response to the new evidence. For example, Professor Peter Horby, Chair of the New and Emerging Respiratory Virus 206 Oral evidence taken before the Science and Technology Committee …

136 Conclusion

The second wave of the pandemic was more numerous in terms of hospital admissions and deaths than the first wave. It peaked on 8 January 2021 with 68,053 new infections per day reported in the UK,214 and on 20 January with 1,820 deaths.215 This wave was dominated by the Alpha …

137 Conclusion

Due to the much higher transmissibility of the Alpha variant, in the absence of a test, trace and isolate system capable of arresting the spread of the virus, a circuit-breaker in September and an earlier, more stringent lockdown, would likely have reduced deaths. Had more stringent social distancing measures been …

138 Conclusion

But these decisions were taken before the existence of the Alpha variant was known. So the justification for an earlier lockdown is greatly influenced by information that was not available at the time. It serves to illustrate that, in a pandemic whose course is unknown, some decisions will be taken …

139 Conclusion

Several public health experts stressed to us that an effective messaging and communications strategy was a crucial part of the response to a pandemic. In July 2020, Sir Paul Nurse argued in evidence to the Health and Social Care Committee that “communication, messaging and keeping trust” should be one of …

140 Conclusion

At the outset of the pandemic, the Prime Minister’s “stay at home” order was accompanied by a public messaging campaign that clearly instructed the public to “stay home, protect the NHS, save lives”. This message was driven by regular televised press conferences from Number 10 Downing Street, during which Ministers …

141 Conclusion

Much of the evidence to our inquiry has acknowledged that this “Stay at Home” slogan was successful in fostering sufficient levels of awareness and understanding among the public. For example, during this period there was a marked fall in the number of people travelling on the roads and using recreational …

142 Conclusion

Evidence from University College London (UCL) showed that during the first lockdown, the simplicity and clarity of public health messaging did indeed translate into high levels of compliance with the stay at home order. According to UCL, during this period “levels of understanding were reported by individuals to be very …

143 Conclusion

Although the communications strategy in the initial phase of the pandemic was broadly successful, it is worth noting that there was some confusion over who the stay at home order applied to, and there was criticism of the Government’s decision not to provide a British Sign Language (BSL) interpreter on-set …

144 Conclusion

On 10 May 2020, the Government announced that society would begin to reopen in England through a staged series of lockdown easing measures.226 From this point, there were divergent approaches to messaging across the four nations of the UK. To reflect the gradual lifting of strict lockdown measures in England, …

145 Conclusion

Written evidence to our inquiry suggested that the loss of consistency across the four nations led to confusion, with “messages from numerous national bodies that, at times, appeared to contradict each other”.229 We heard that at this stage, these contradicting messages began to cause confusion. Professor Devi Sridhar, speaking to …

146 Conclusion

The three-tier approach to local lockdown restrictions in England (see paragraph 117) introduced more complexity to Government messaging which was, understandably different in different parts of the country.231 It was therefore unsurprising that this more differentiated messaging strategy meant that levels of public understanding and compliance began to deteriorate. Written …

147 Conclusion

Written evidence suggested that the inconsistency in Government messaging after the first wave of the pandemic was also damaging to public trust in official information.233 Analysis submitted by Leeds Beckett University showed that most members of the public did not trust information from the UK Government and that they were …

148 Conclusion

Lower levels of public trust and understanding of the regulations also created a gap into which misinformation was able to spread. Research conducted by Ofcom in the first six weeks of the pandemic found that 47% of respondents said they had come across false or misleading information about covid-19 in …

149 Conclusion

The covid pandemic is a global emergency that is not yet over. While the UK’s trajectory may have changed in recent months with vaccines, the vast majority of the world is still grappling with the disease. It would be prudent to reserve judgement on the UK’s performance until the pandemic …

150 Conclusion

One of the key ways to measure a country’s success in fighting covid-19 is to measure deaths from covid-19. However, countries across the world measure deaths in different ways. The UK has reported covid deaths as those who died within 28 days of a positive test. The UK also offers …

151 Conclusion

There are also other factors to be considered. Each country has a unique set of characteristics which might have contributed to its health related covid-19 outcomes. For example, the UK has the tenth-highest rate of obesity in the world,241 which is linked to an increased risk of adverse outcomes.242 Conclusions …

152 Conclusion

During the first three months of the covid pandemic, the UK followed the wrong policy in its use of non-pharmaceutical interventions. When the UK moved from the ‘contain’ to ‘delay’ stage, there was a policy of seeking to only moderate the speed of infection through the population—flattening the curve—rather than …

153 Conclusion

The flattening the curve policy was implemented by introducing new restrictions only gradually and slowly, acting as if the spread of the virus were susceptible to calibrated control. Modelling at the time suggested that to suppress the spread of covid-19 too firmly would cause a resurgence when restrictions were lifted. …

154 Conclusion

There are several possible explanations for what was a significant error in policy and advice early in the pandemic. These include: • the lack of adequate data on the spread of covid-19, as a result of the inadequacy of the UK testing operation; • overreliance on specific mathematical models when …

155 Conclusion

Science proceeds through challenge and disputation, and new theories are tested unflinchingly against evidence. Yet Ministers and other advisers reported that they felt it difficult to challenge the views of their official scientific advisers. Those in Government have a duty to question and probe the assumptions behind any scientific advice …

156 Conclusion

The second wave of covid infections, hospitalisations and deaths during the autumn and winter of 2020/21 was significantly driven by the emergence of a new variant, known as the Kent or Alpha variant. It is likely that a “circuit break” of temporary lockdown measures if introduced in September 2020, and …

157 Conclusion

Government public health communications are key to the public’s understanding of and compliance with non-pharmaceutical interventions. Initial messaging from the Government early in the pandemic was strong, effective and undoubtedly contributed to the success of the first lockdown. After the gradual lifting of the first lockdown Coronavirus: lessons learned to …

158 Conclusion

In the early days of a crisis, scientific advice may be necessarily uncertain: data may be unavailable, knowledge limited and time may be required for analysis to be conducted. In these circumstances it may be appropriate to act quickly, on a precautionary basis, rather than wait for more scientific certainty.

159 Conclusion

In future an approach of greater questioning and challenge should characterise the development of policy. Ministers should have the confidence to follow a scientific approach themselves—being prepared to take a more robust approach to questioning and challenging the advice given. The Government and SAGE should also facilitate strong external and …

160 Conclusion

In bringing together many of the UK’s most accomplished scientists, SAGE became a very UK body. In future, it should include more representation and a wider range of disciplines, from other countries, especially those which have experienced, or are experiencing, the same emergency.

162 Conclusion

The Government, via the World Health Organisation, should make the case for an international standard of reporting covid-19 deaths and a framework for reporting disease related deaths for future pandemics. 60 Coronavirus: lessons learned to date 4 Testing and contact tracing

163 Conclusion

While, as we will illustrate in Chapter 7, the UK’s vaccination programme has been a national success, the record during the pandemic of the test, trace and isolate programme is more mixed. The slow, uncertain, and often chaotic performance of the test, trace and isolate system during the first phases …

164 Conclusion

This Chapter looks at a number of different facets of the test, trace and isolate system— though they are illustrative rather than exhaustive. While it describes an unsatisfactory history, there are signs that the UK has now arrived at a more dependable outcome: the UK now has, in principle, the …

165 Conclusion

In this Chapter we consider in particular: • the initial testing capacity available; • the decision to abandon testing in the community; • the 100,000 tests a day target introduced by the then Secretary of State; • the centralisation of testing laboratories; • the shortage of testing capacity in Autumn …

166 Conclusion

During the early days of the pandemic, the Government believed—and told the public—that testing for covid-19 was a field in which the UK had a leading position. This assessment was shared, and possibly arose out of, the views of scientific advisers. The minutes of the very first SAGE meeting on …

167 Conclusion

SAGE minutes from 28 January 2020 recorded that notwithstanding the scientific lead in establishing a test, PHE only had operational capacity to administer “400 to 500 tests per day” for the whole country.248 Other countries such as South Korea and Hong Kong, who did not benefit from our lead in …

168 Conclusion

Professor Martin explained to us that early in the pandemic there were “very severe constraints in equipment and consumables” which acted as a drag on testing capacity: Bear in mind that those were all new tests coming on stream at the beginning of the pandemic. Effectively, there was not enough …

169 Conclusion

However, throughout the pandemic, our Committees have taken a great interest in what might be learned and applied from how other countries tackled the virus. In March 2020, the World Health Organisation recommended that nations “plan for surge capacity by establishing decentralized testing capacity in sub-national laboratories”.252 Dr Seon Kui …

170 Conclusion

In evidence to the Science and Technology Committee on 25 March 2020 Public Health England claimed to have formally studied, but rejected, the South Korean approach.255 Despite repeated requests by the Committee no evidence of such an evaluation has ever been produced. We must conclude that no formal evaluation took …

171 Conclusion

As a result the UK squandered a leading position in diagnostics and converted it into one of permanent crisis. On 12 March, testing for covid-19 other than in hospitals was halted. In part this was because of the inadequacy of the early flu-based strategy—a flu-strategy which mandated ending testing when …

172 Conclusion

Shortly after this seminal failure, in mid-March 2020 responsibility for the testing strategy was taken over by the Department of Health and Social Care from Public Health England.256 It was not until 18 May 2020, when the first wave of covid-19 had begun to wane in the UK, that widespread …

173 Conclusion

The consequences of this initial failure were profound. Testing not only allowed individuals to be identified who had covid-19—and were infectious—but test results for an invisible virus were the only way to be able to accurately monitor the incidence and spread of the virus across the country, and to understand …

174 Conclusion

For a country with a world-class expertise in data analysis, to face the biggest health crisis in a hundred years with virtually no data to analyse was an almost unimaginable setback. The reasons for this initial inadequacy to translate testing technology into deployable testing capacity are varied. Public Health England …

175 Conclusion

We also consider that the Government’s scientific advisers were too passive in accepting assurances that the clinical operational capacity of Public Health England could not be changed. Even in March 2020, Professor Neil Ferguson explained that “much 254 Q129 255 Oral evidence taken before the Science and Technology Committee on …

176 Conclusion

It is clear that there should have been more challenge to Public Health England to increase testing capacity from the outset by Ministers, scientific advisers and the Department of Health and Social Care rather than accepting it as a fait accompli. Consequences of abandoning testing in the community

177 Conclusion

As noted earlier, the failure to have enough testing capacity in the early weeks of the pandemic contributed to a lack of knowledge as to how the infection was spreading in the country. Speaking to us in November 2020, Professor Sir Chris Ham, Chair of the Coventry and Warwickshire Sustainability …

178 Conclusion

The lack of data resulting from suspending community testing also affected the UK’s understanding of the disease at that critical time. Professor Neil Ferguson explained to the Science and Technology Committee in June 2020 that low testing capacity meant it was difficult to estimate the proportion of imported cases which …

179 Conclusion

Professor Chris Whitty told the Health and Social Care Committee in July 2020 that the lack of testing capacity available at the beginning of the pandemic meant that the Government had to focus resources very closely on the hospital sector, and in particular intensive care units.265 Within hospitals, the prioritisation …

180 Conclusion

The lack of available testing for social care was particularly damaging, as we discuss in more detail later in this Report. Crucially, it was not until mid-April that covid-19 testing was made a requirement for people discharged from hospital to social care—even on 2 April 2020 guidance still stated that …

181 Conclusion

The Health and Social Care Committee’s Reports on social care and the delivery of core NHS and care services during the pandemic also highlighted the impact of a lack of testing for social care staff in the initial wave of the pandemic. Evidence from across the sector, including from staff …

182 Conclusion

Following the initial shortage of testing capacity and the slow increase in the availability of tests during the critical first eight weeks of the pandemic, responsibility for the testing strategy was removed from Public Health England and vested in the Department of Health and Social Care. On 2 April the …

183 Conclusion

Subsequently, Dominic Cummings, in evidence to our inquiry, strongly criticised the then Secretary of State for naming this target, describing it as “an incredibly stupid thing to do.”272 However, Mr Hancock defended the target, saying to the Committees, “that 100,000 target was essential in galvanising the whole system and building …

184 Conclusion

Given the painfully slow increase in the availability of testing before April 2020, we consider that the impact of the Secretary of State’s target to have been an appropriate one to galvanise the rapid change the system needed. However, as such a personal and unilateral approach was needed—and appears not …

185 Conclusion

As a result of the increase in testing capacity driven during April, the UK Government finally resumed community testing on 18 May 2020, following an expansion of capacity, which included more than a doubling of the NHS and PHE laboratory network capacity.274 In its April 2020 testing strategy, the Department …

186 Conclusion

Evidence received by the Science and Technology Committee suggested that taking a centralised approach to increasing testing capacity was appropriate as it might not have been practical to focus on boosting local-level capacity alone. For example, Dr Richard Harling, Director of Health and Care for Staffordshire County Council, suggested that …

187 Conclusion

However, both our Committees heard that other resources could have been used more effectively in the initial expansion of testing capacity. Professor Sir Chris Ham explained that initially the Government was “very much focused on building capacity in the commercial Lighthouse laboratories” but suggested that this focus was to the …

188 Conclusion

Despite this, it appeared that there was a disconnect between the testing operation in the Lighthouse Laboratories and NHS labs. For example, the Institute of Biomedical Science suggested that there was a “lack of integration and collaboration” between the laboratories providing Pillar 1 testing (NHS and PHE labs) and Pillar …

189 Conclusion

Throughout the last 18 months, the test and trace system has had labels applied that have been at variance with the reality. Ministers began by promising the test and trace system would be “world-beating” in May 2020 when the truth was that it was that it was a laggard.284 Antibody …

190 Conclusion

In May 2020 the label “NHS” was applied by the Department of Health and Social Care to the test and tracing system, despite it being operated outside the NHS. It was notable that in evidence to our inquiry, the then Chief Executive of NHS England, Sir Simon Stevens, pointedly refused …

191 Conclusion

The Government has pursued both mass antibody testing (to identify who previously had covid-19) and mass diagnostic testing (to identify those currently infected) as means to return to normality. In its April 2020 testing strategy, the Government said it was “committed to mass testing” and stated its “overall ambition is …

192 Conclusion

That optimism does not appear to have been shared by scientists advising the Government, who struck a more cautious note. For example, at the same press conference Sir Patrick Vallance pointed out that the technologies still had to be trialled, saying that it was “completely wrong to assume this is …

193 Conclusion

As with other aspects of covid-19 testing, the Government has put a significant amount of public money towards mass testing. The NAO’s December 2020 report on test and trace indicated that (leading up to October) £2.9 billion had been earmarked for mass testing, over twice the budget allocated to tracing …

194 Conclusion

During the summer of 2020, rates of covid infection declined markedly in most parts of the United Kingdom. Average hospitalisations from covid fell to 119 per day on 1 August 2020 compared to 3,000 per day in early April. Yet as soon as infections began to rise in September 2020—when …

195 Conclusion

Despite undergoing a large increase in testing capacity over the first lockdown period— reaching over 200,000 daily tests by the beginning of June 2020298—the test and trace service in England then struggled to keep up with a sharp increase in demand following the reopening of schools and universities in September …

196 Conclusion

During September 2020, the Science and Technology Committee heard from Baroness Harding that NHS Test and Trace had “planned for a sizeable increase” but that she “[did] not think anybody was expecting” the level of demand experienced.301 She explained one reason for the surge was that a proportion of ineligible …

197 Conclusion

The NAO’s December 2020 report pointed out further that NHS Test and Trace was unable to meet demand due to insufficient laboratory capacity as a result of: • delays in getting new laboratories up and running; • delays in delivering testing equipment, including supply chain problems with swabs, screening kits …

198 Conclusion

Two months earlier, in July 2020, the Government Chief Scientific Adviser, Sir Patrick Vallance, told the Science and Technology Committee that extra testing capacity would be “essential” ahead of schools reopening.306 However, he suggested that the Government did 298 GOV.UK, UK reaches 200,000 coronavirus testing capacity target a day early: …

199 Conclusion

Overall, the National Audit Office concluded that NHS Test and Trace “did not plan for a sharp rise in testing demand in early Autumn [2020]” and was therefore “unprepared.”311 Professor Chris Whitty reiterated to both Committees in December 2020 that one key learning was the need to scale up testing …

1 Conclusion

Para 58

The UK has established procedures and structures to prepare for the nation’s major future risks, including a National Risk Register, the Civil Contingencies Secretariat and the Scientific Advisory Group for Emergencies (SAGE). However, the anticipated future risk of pandemic disease focused too closely on influenza rather than diseases like SARS …

2 Conclusion

Para 59

Previous exercises to test the national response capability, namely Exercises Cygnus and Winter Willow, did not squarely address a disease with the characteristics of covid-19. Nevertheless, some useful lessons were learned and applied, such as the drafting of legislative measures that might be needed.

3 Conclusion

Para 60

The operation of COBR was not well-suited to the modern demands of a pandemic response. It is especially concerning that its culture of confidentiality was considered by some to be so unreliable that alternative meetings were arranged that could command greater confidentiality among participants.

4 Conclusion

Para 61

The Civil Contingencies Secretariat did not have adequate resources to maintain a substantial standing capability to survey the development of potential threats, and it had a limited reach into the range of Government departments required to respond to a pandemic. The experience has been that this investment in resilience is …

5 Conclusion

Para 62

Protocols to share data between public bodies involved in the response were too slow to establish and to become functional. This was especially true in the data flows from national to local government.

6 Conclusion

Para 63

The NHS responded quickly and strongly to the demands of the pandemic, but compared to other health systems it “runs hot”—with little spare capacity built in to cope with sudden and unexpected surges of demand such as in a pandemic.

7 Conclusion

Para 64

A greater diversity of expertise and challenge—including from practitioners from other countries and a wider range of disciplines—should be included in the framing of the National Risk Register and the plans that emanate from it. Plans for the future should include a substantial and systematic method of learning from international …

8 Conclusion

A standing capability should be established in Government, or reporting to it, to scan the horizon for future threats, with adequate resource and counting on specialists with an independence from short-term political and administrative pressures. (Paragraph 65) Coronavirus: lessons learned to date 125

10 Conclusion

Para 67

The resourcing and capabilities of the Civil Contingencies Secretariat should be improved. The Civil Contingencies Secretariat should be empowered to ‘stress test’ plans and to ensure that Departments are able to carry out a contingency plan if required. The details and results of these stress tests should be included in …

11 Conclusion

Para 68

Arrangements should be established and tested to allow immediate flows of data between bodies relevant to an emergency response with a mechanism to resolve immediately and decisively any disputes.

12 Conclusion

Para 69

The Armed Forces should have a more central and standing role in preparing for and responding to emergencies like pandemics, given the depth of capability and experience they have in planning, logistics and rapid mobilisation. The Civil Contingencies Secretariat should work with the Armed Forces to improve operational expertise in …

13 Conclusion

Para 70

The Government and the NHS should consider establishing a volunteer reserve database so that volunteers who have had appropriate checks can be rapidly called up and deployed in an emergency rather than needing to begin from scratch.

14 Conclusion

Para 71

The experience of the demands placed on the NHS during the covid-19 pandemic should lead to a more explicit, and monitored, surge capacity being part of the long term organisation and funding of the NHS.

15 Conclusion

Para 72

The NHS should develop and publish new protocols for infection prevention and control in pandemics covering staffing, bed capacity and physical infrastructure. In developing these protocols the NHS should consider the importance of maintaining access for people accompanying some patients such as advocates for people with learning disabilities and birthing …

16 Conclusion

Para 73

Comprehensive analysis should be carried out to assess the safety of running the NHS with the limited latent capacity that it currently has, particularly in Intensive Care Units, critical care units and high dependency units.

17 Conclusion

Building on the experience of staff working more flexibly during the pandemic and to enable more flexible staffing in the NHS, NHS England and Health Education England should develop proposals to better enable NHS staff to change clinical specialty mid- career and train in sub-specialties. (Paragraph 74) Lockdowns and social …

18 Conclusion

Para 152

During the first three months of the covid pandemic, the UK followed the wrong policy in its use of non-pharmaceutical interventions. When the UK moved from the ‘contain’ to ‘delay’ stage, there was a policy of seeking to only moderate the speed of infection through the population—flattening the curve—rather than …

19 Conclusion

Para 153

The flattening the curve policy was implemented by introducing new restrictions only gradually and slowly, acting as if the spread of the virus were susceptible to calibrated control. Modelling at the time suggested that to suppress the spread of covid-19 too firmly would cause a resurgence when restrictions were lifted. …

20 Conclusion

There are several possible explanations for what was a significant error in policy and advice early in the pandemic. These include: • the lack of adequate data on the spread of covid-19, as a result of the inadequacy of the UK testing operation; • overreliance on specific mathematical models when …

21 Conclusion

Para 155

Science proceeds through challenge and disputation, and new theories are tested unflinchingly against evidence. Yet Ministers and other advisers reported that they felt it difficult to challenge the views of their official scientific advisers. Those in Government have a duty to question and probe the assumptions behind any scientific advice …

22 Conclusion

Para 156

The second wave of covid infections, hospitalisations and deaths during the autumn and winter of 2020/21 was significantly driven by the emergence of a new variant, known as the Kent or Alpha variant. It is likely that a “circuit break” of temporary lockdown measures if introduced in September 2020, and …

23 Conclusion

Para 157

Government public health communications are key to the public’s understanding of and compliance with non-pharmaceutical interventions. Initial messaging from the Government early in the pandemic was strong, effective and undoubtedly contributed to the success of the first lockdown. After the gradual lifting of the first lockdown from May 2020, Government …

24 Conclusion

Para 158

In the early days of a crisis, scientific advice may be necessarily uncertain: data may be unavailable, knowledge limited and time may be required for analysis to be conducted. In these circumstances it may be appropriate to act quickly, on a precautionary basis, rather than wait for more scientific certainty.

25 Conclusion

Para 159

In future an approach of greater questioning and challenge should characterise the development of policy. Ministers should have the confidence to follow a scientific approach themselves—being prepared to take a more robust approach to questioning and challenging the advice given. The Government and SAGE should also facilitate strong external and …

26 Conclusion

In bringing together many of the UK’s most accomplished scientists, SAGE became a very UK body. In future, it should include more representation and a wider range of disciplines, from other countries, especially those which have experienced, or are experiencing, the same emergency. (Paragraph 160) 128 Coronavirus: lessons learned to …

28 Conclusion

The Government, via the World Health Organisation, should make the case for an international standard of reporting covid-19 deaths and a framework for reporting disease related deaths for future pandemics. (Paragraph 162) Testing and contact tracing

29 Conclusion

Para 232

Despite being one of the first countries in the world to develop a test for covid in January 2020, the United Kingdom failed to translate that scientific leadership into operational success in establishing an effective test and trace system during the first year of the pandemic. Public Health England showed …

30 Conclusion

Para 233

Testing capacity was treated too much as a parameter rather than a variable that could be changed by the Department of Health and Social Care and scientific advisers. What was being achieved in other countries, particularly East Asia, appeared to be of little interest in the initial weeks of the …

31 Conclusion

Para 234

The resulting requirement to abandon testing people in the community during the critical early period of the pandemic cost many lives for a number of reasons including because: a) many asymptomatic carriers were not tested and therefore identified and asked to isolate; b) many older people were admitted to care …

32 Conclusion

Para 235

The new Test and Trace operation eventually established in May 2020 was a step in the right direction but set up much too late. Because of that delay there was huge pressure to get results quickly which meant that it followed a centralised model initially, meaning assistance from laboratories outside …

33 Conclusion

Para 236

Vast sums of taxpayers’ money were directed to Test and Trace, justified by the benefits of avoiding further lockdowns. But ultimately those lockdowns happened. Were it not for the success of the Vaccine Taskforce and the NHS vaccination programme, it is likely that further lockdown restrictions would have been needed …

34 Conclusion

Para 237

We recognise that the effectiveness of test and trace in reducing transmission is likely to be reduced when the prevalence of the virus is high, as highlighted by Professor Whitty and others, but it is clear from the latest data and the experience of September 2020 that even at the …

35 Conclusion

Para 238

The Test and Trace organisation has not, despite its branding, been run by the NHS, and has seen senior executives brought in from external bodies for short term contracts which reduces the institutional learning, from what was an intense period, that has been retained. It is a major concern that …

36 Conclusion

Para 239

Partly because it was set up too late, NHS Test and Trace ultimately fell short of the expectations set for it. It has failed to make a significant enough impact on the course of the pandemic to justify the level of public investment it received. It clearly failed on its …

37 Conclusion

The National Audit Office has stated that “to achieve value for money NHST&T must be able to demonstrate both that the interventions it delivers are effective in achieving its objective, and that the mix of interventions is the most cost-effective use of public resources.” After 18 months and many billions …

39 Conclusion

Para 242

Public Health England and its successor bodies, as well as Ministers and their scientific advisers, should be more willing to study and emulate the practice of other countries with urgency and agility, especially during a crisis. A culture must be established that looks proactively to collaborate with other organisations, rather …

41 Conclusion

Para 244

The reactive, short-term horizon of test and trace for much of the pandemic must be replaced by a capacity for anticipation and preparation—even during the course of an emergency.

42 Conclusion

The organisation of the bodies responsible for testing and tracing should be open and transparent both about their operations and the basis of their decisions. (Paragraph 245) Social care

43 Conclusion

Para 288

The covid-19 pandemic has put massive strain on a social care sector already under huge pressure, which has a particular focus on caring for elderly people who have been at the greatest risk of death from covid.

44 Conclusion

Para 289

Social care had a less prominent voice in Government during the early stages of the pandemic than did the NHS.

45 Conclusion

Para 290

The discharge of elderly people from NHS hospitals into care homes without having been tested at the beginning of the pandemic—while understandable as the NHS prepared to accept a surge of covid patients—had the unintended consequence of contributing to the spread of infection in care homes. The seeding of infections …

46 Conclusion

Staff shortages, the lack of testing, difficulties in obtaining PPE and the design of care settings to enable communal living hampered isolation and infection control and the ability to keep covid at bay. Social care staff in care homes and providing domiciliary care worked under strenuous conditions, at risk to …

47 Conclusion

Para 292

Many of these pressures on the social care sector—such as funding and workforce— are longstanding and must be resolved urgently. Pressures on the social care workforce are likely to be compounded this autumn by the mandate that people working in the social care sector must be fully vaccinated to continue …

48 Conclusion

Para 293

Planning for future pandemics should have a more developed and explicit consideration of the intense interaction between the NHS and social care. The prominence of social care within the Department of Health and Social Care should be enhanced and Ministers must address the relative lack of knowledge and experience of …

49 Conclusion

Para 294

Long term reform of social care is overdue and should be pursued as a matter of urgency. The Government’s recent announcement on the future of social care is welcome, but the long-term future of the sector remains unresolved. We endorse the Health and Social Care Committee’s call for a 10 …

50 Conclusion

Para 295

We endorse the Health and Social Care Committee’s call for additional resources to be directed to social care. That Committee has made the case for an increase of £7 billion a year by 2023/4. We note that despite the Government’s recent announcement the level of new investment in social care …

52 Conclusion

Para 330

The impact of covid-19 has been uneven across the population, with some sections of society suffering significantly higher illness and deaths than the nation as a whole.

53 Conclusion

During the initial phase of the pandemic Black, Asian and minority ethnic people experienced significantly higher levels of severe illness and death from covid than was typical the population as a whole. Research conducted so far suggests that the drivers of these elevated levels of impact among Black, Asian and …

54 Conclusion

Para 332

Staff from Black, Asian and minority ethnic backgrounds are crucial to the NHS and care sectors. The covid-19 pandemic has brought the experiences of these staff into sharp focus. It is telling that the first ten NHS staff to die from covid-19 were from Black, Asian and minority ethnic backgrounds, …

55 Conclusion

Para 333

People with learning disabilities have experienced significantly higher death rates from covid-19 than the country as a whole. Deaths have been especially high among younger adults with learning disabilities. Initial research suggests that people with learning disabilities entered the pandemic from a position of heightened vulnerability because of existing comorbidities. …

56 Conclusion

Para 334

Although there was never national NHS guidance to apply “Do not attempt CPR” (DNACPR) notices to people with learning disabilities, there have been widespread concerns that there were cases in which they have been issued inappropriately during the pandemic.