Reports & recommendations

The UK government should:

abolish the lead government department model for whole-system civil emergency preparedness and resilience; and
require the Cabinet Office to lead on preparing for and building resilience to whole-system civil emergencies across UK government departments, including monitoring the preparedness and resilience of other departments, supporting departments to correct problems, and escalating issues to the UK Cabinet-level ministerial committee and group of senior officials in Recommendation 1.

The UK government and devolved administrations should together introduce a UK-wide whole-system civil emergency strategy (which includes pandemics) to prevent each emergency and also to reduce, control and mitigate its effects.

As a minimum, the strategy should:

be adaptable;
include sections dedicated to each potential whole-system civil emergency – for example, one on pandemics with a clear explanation of the roles and responsibilities of the UK government, devolved administrations and their departments/directorates as well as local responders;
consider a wide range of potential scenarios for each type of emergency;
identify the key issues and set out a range of potential responses;
identify how the strategy is to be applied to ensure that any potential responses are proportionate to the particular circumstances of the emergency;
include an assessment in the short, medium and long term, based on published modelling, of the potential health, social and economic impacts of the emergency and of potential responses to the emergency on the population and, in particular, on vulnerable people; and
include an assessment of the infrastructure, technology and skills the UK needs to respond effectively to the emergency and how those needs might change for different scenarios.

The strategy should be subject to a substantive reassessment at least every three years to ensure that it is up to date and effective, incorporating lessons learned between reassessments.

The governments of the UK, Scotland, Wales and Northern Ireland should each produce and publish reports to their respective legislatures at least every three years on whole-system civil emergency preparedness and resilience. The reports should include as a minimum: the risks that each government has identified are likely to result in whole-system civil emergencies; the recommendations that have been made to each government to mitigate those risks, and whether these recommendations have been accepted or rejected; a cost–benefit analysis setting out the economic and social costs of accepting the risks as against taking action to mitigate the risks; who may be vulnerable to the risks and what steps are being taken to mitigate those risks; a plan setting out the timescales for implementing the recommendations that have been accepted; and an update on the progress that has been made on implementing previously accepted recommendations.

The UK government and devolved administrations should ensure that the draft affirmative procedure is the standard process for enacting substantial and wide-ranging powers in a civil emergency, such as a pandemic, under primary public health legislation.

Any departure from this procedure should be the exception, with clear criteria and safeguards in place to prevent the bypassing of parliamentary scrutiny. These safeguards should include:

‘sunset clauses’ for regulations made using the made affirmative procedure, specifying a clear expiration date, typically within two months; and
a duty on ministers to report to their respective legislatures every two months on the exercise of emergency powers.

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should develop an online portal for use in future civil emergencies, where members of the public can access information on the legal restrictions that apply in their area and any associated guidance.

This portal should be easily accessible and its content should be written in straightforward and unambiguous language.

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive, in conjunction with organisations responsible for delivering services, should plan for surge capacity in urgent and emergency care during a pandemic. Plans must ensure that there is sufficient workforce capacity and the ability to surge, including the number and type of staff required, recruitment and training provision. This should be completed as part of the whole-system civil emergency strategy recommended in the Inquiry's Module 1 Report (Recommendation 4). Plans should be published and subject to review every three years.

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should work with trusts and health boards to ensure that pandemic plans include practical steps to rapidly scale up hospital capacity to treat acutely unwell patients. This should include critical care services that can deliver multiple levels and types of organ support. It should also cover necessary equipment, supplies, space and staff, including redeployment and training. All trusts and health boards must keep an easily accessible, up-to-date record of the information needed to implement these plans in the hospital sites they operate. This should include technical aspects of critical care expansion such as power, ventilation, oxygen and waste management systems. Plans for expanding capacity should be published, subject to review every three years and tested as part of the pandemic response exercises recommended in the Inquiry's Module 1 Report (Recommendation 6).

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive, working with healthcare employers and professional bodies, should put in place plans to deliver effective support for healthcare workers at scale from the outset of a pandemic. Plans should cover the nature and level of support that will be provided during and after a pandemic. All four governments should develop a programme of peer support visits that can, from the outset of a pandemic, be targeted towards areas of acute hospitals under considerable strain. The purpose of the visits should be to support front-line staff, collect insights on the pressures that healthcare workers are facing and understand what further support they might need.

The UK government should establish a standing pharmaceutical expert advisory panel, in consultation with the Department of Health and Social Care and the Department for Science, Innovation and Technology. The panel should include ministers, civil servants and representatives from industry and academia, and be led by an independent Chair with experience of working in a relevant industry. The panel's role should be to: oversee the UK's preparedness to develop, procure and manufacture pharmaceuticals (vaccines and therapeutics) in the event of a pandemic or health emergency, assisting with cross-government strategy development; ensure that the UK government and devolved administrations, their agencies, industry and academia are aligned around shared goals in developing vaccines and therapeutics for pandemic diseases; oversee strong links between government and the pharmaceutical industry; advise the UK government on how to incentivise pharmaceutical companies to invest in manufacturing facilities and research in the UK; and advise the UK government on its research investments, with a view to ensuring a diverse portfolio of pharmaceutical research in the UK. During a pandemic, the panel should form the basis of specialist taskforces, which would be responsible for securing and developing medical interventions and leading on their procurement on behalf of the four nations of the UK. They should have sufficient autonomy, delegation and direct access to senior ministers, similar to that which worked well in the Covid-19 pandemic.

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should maintain networks with local communities to produce targeted vaccination strategies and communications. To achieve this: The Scottish Government, Welsh Government and Northern Ireland Executive should establish local community networks, mirroring the approach being taken by the UK Health Security Agency. All four governments should work with their network to identify specific and measurable actions to improve vaccine uptake and reduce inequalities and consult with these networks on communications campaigns and delivery approaches. All four governments should publish a report annually on progress against these actions.

The UK government and devolved administrations should work together, with their respective health delivery services, to facilitate and coordinate regulatory bodies' access to healthcare records in order to make the post-authorisation safety monitoring of new vaccines and therapeutics more efficient. In particular, the Medicines and Healthcare products Regulatory Agency should be granted specific and proportionate access to comprehensive and comparable data from across the four nations of the UK, including linked primary and secondary healthcare data records. This should include data on vaccines and therapeutics administration. This improved linkage must be accompanied by strong safeguards for patient confidentiality, which the Information Commissioner's Office should work with the four governments to ensure.

The UK government must reform the Vaccine Damage Payment Scheme as soon as possible. The reform should include as a minimum: increasing the £120,000 payment, at least in line with inflation to date; subsequently applying annual increases in line with inflation; introducing multiple levels of payment, commensurate with the degree of injury suffered; and any transitional arrangements necessary to provide for fairness between applicants to the existing scheme and applicants to the revised scheme.