Covid: UK government wasn't ready for pandemic, report finds

[AnnieS]

a precis of this in your own words?

[Omah]

Summary of findings

Four key areas of improvement

Develop a “concept of operations”

During Exercise Cygnus, the strategy used was a combination of Department of Health and Social Care’s UK Influenza Pandemic Preparedness Strategy 2011, as well as eight or more other scientific documents gleaned from the H1N1 pandemic in 2009. However, the exercise revealed that there was no overview or central management to coordinate all participants. As of October 2016, feedback showed that organisations varied in preparedness, with some relying on corporate memory of the 2009 H1N1 response, and others depending on individual pandemic protocols which may be outdated, missing or incomplete.(Exercise Cygnus - Wikipedia) There was also demonstration of silo planning between and within some corporations, however organisations had different levels of detail and structure that could not correspond well when used simultaneously.(Exercise Cygnus - Wikipedia) It was understood that up to half the population will be implicated should there be insufficient understanding of the severity of a pandemic during the response.(Exercise Cygnus - Wikipedia)

Exercise Cygnus revealed the need to develop a “Pandemic Concept of Operations” to bridge communication between organisations.(Exercise Cygnus - Wikipedia) This aims to manage collective response strategically by delegating specific roles to each organisation and directing their interactions during a pandemic. NHS England recognises that a variety of sectors are implicated, hence a central administration and unified protocol to oversee the whole strategy is required for organisations to work synonymously.(Exercise Cygnus - Wikipedia)

Devolved administrations have separate contingency plans which were not investigated during Exercise Cygnus. In this segment, Wales was also excluded as it had previously investigated its response through “Exercise Cygnet” conducted in 2015.[5]

Ease legislation during pandemic

The proposition to roll back on legislation and regulatory restrictions, particularly within the health sector, is considered.(Exercise Cygnus - Wikipedia) This would aid in managing essential services and operationalising increased health care demands with fewer obstacles. Greater flexibility is recommended especially in a pandemic when situations evolve quickly and decisions need to be made as soon as possible. Key suggestions were for rules to be more malleable and easily adapted to the circumstance at hand. The choices as to which legislation will be amended is determined by pandemic influenza planning assumptions. Previous findings from Department of Health and Social Care provide direction as to what type of corrections are appropriate for health legislation in the midst of a pandemic.

Devolved administrations were advised to adopt similar measures in fields of devolved competence. The need for future work to expand on the types of restrictions affected was noted.

Understand and manage public reaction

Exercise Cygnus was centred around assumptions of public responses that have yet to be validated. Expectations of how the public will react was postulated based on the magnitude of “swan flu”. This may not have been entirely representative of what would have happened in real life.(Exercise Cygnus - Wikipedia) For example, Exercise Cygnus did not involve live broadcasting or widespread coverage which typically characterises an actual pandemic. Hence, its reactions are based around theoretical public reaction. This was identified and understood as a possible limitation to Exercise Cygnus, and the role of public opinion on pandemic response still requires further investigation. It was stated that in reality, moral decisions, such as those involving mass burials or population triage, may differ in face of public reaction.(Exercise Cygnus - Wikipedia)

Further work is required to understand public reaction, so that it can be factored into significant decisions and communication strategies, particularly for ethically charged scenarios. Research into how public perception and response to a pandemic will further aid the trajectory of emergency strategies and how they can be communicated. In 2019, the Moral and Ethical Advisory Group (MEAG) was established to give unbiased guidance to government regarding controversial health issues.(Exercise Cygnus - Wikipedia)

Meet demand for services

A lack of resources and limited ability to increase supply in face of demand was identified in health disciplines.Exercise Cygnus - Wikipedia) This affects how emergency plans can be operationalised at a local level, implicating the revision of the “Pandemic Concept of Operations”.

Little tactical coordination was observed when the need for services outweighed the capacity of local responders, particularly in communities with excess death, social care facilities and amongst National Health Service staff.(Exercise Cygnus - Wikipedia) The need for more precise protocols was identified to guide health care providers at an operational level should there be a need to drastically step up local response. A suggestion was to implement planning at a regional level as opposed to through local resilience forums for crucial aspects of pandemic influenza response (e.g., excess death). This improves coordination across multiple agencies locally.

Logistically, more health workers and resources such as ventilators, personal protective equipment (PPE) and hospital beds are required to face a large pandemic. Investigation also showed that the reverse triage strategy proposed by the NHS, whereby patients are moved from hospitals to social care, may not be well supported by the current social care system.(Exercise Cygnus - Wikipedia) This requires a high level of teamwork across several corporations, which was detailed through a provided framework but may not be viable under the pressure and widespread impact of a pandemic.

Local resilience forums have announced that they depend on subject matter experts for more complicated aspects of pandemic response to implement responses.(Exercise Cygnus - Wikipedia) These professionals do not belong to LRF but give detailed technical support to enable colleagues to comprehend different elements of the response. The Strategic Coordinating Group (SRG) structure is used by experts for holistic contribution. Doubts were raised if this method was sustainable in the case of a fast-moving pandemic, since experts would have to aid more than one SRG.(Exercise Cygnus - Wikipedia)

Further recommendations

The 22 further recommendations, listed as per the report, include:

1. Corporations are required to update their “Emergency Preparedness Resilience and Response training and exercising” for optimum performance
2. Expert advice from all stakeholders should be readily presented to SCGs for corresponding response. This should occur efficiently so multiple LRFs can benefit from this support.
3. Planning should occur on a national level, and take into account how local pandemic flu strategies can be operationalised in implementation.
4. The health tripartite (DH, NHS England and PHE) and Chief Medical Officers (CMOs) should have Cobra Meetings incorporated into flu response
5. More research needs to be done to investigate if population-based triage is viable during a critical, widespread influenza pandemic
6. More work is required to understand surge arrangements when the pandemic becomes overwhelming. NHS England should direct the operational side while DH should give management, guidance and policy direction with advice from the Four Nations CMO meeting.
7. DH should collaborate with partners to understand how antivirals may be used in a pandemic.
8. PHE and NHS England must cooperate to improve current community guidelines and deliver antivirals within restrictions stipulated by NHS Emergency Preparedness staff.
9. All corporations must be prepared for increased staff absence in the midst of a pandemic and make appropriate plans.
10. Pandemic plans need to be effectively communicated to public for reassurance, and the right amount of detail of disclosed information should be ascertained.
11. Steps to release information to public should be coordinated by DH, NHS England and PHE national teams together with Devolved Administrations
12. A variety of stakeholders needs to be involved during communication of the pandemic to public. Special care is needed in the realm of social media.
13. Cross-government efforts need to be conducted to avoid repetition and redundancy across departments.
14. Department of Education should investigate the impact of school closures on the wider community.
15. British Nationals residing overseas should be taken into account during an influenza.
16. Ministry of Defence should be required to assist in the worst-case scenario.
17. The process and timeline of front line responders need to be made more precise.
18. A framework for analysing social care and surge capacity needs to be established.
19. The potential for increasing social care real-estate and staff numbers need to be examined.
20. Strategies to allocate voluntary resources during a pandemic need to be developed with advice from non-health departments.
21. Excess death management needs review.
22. Pandemic contingency plans and procedures as a whole require more development.

[Omah]

@AnnieS

@Omah

I said:

I find it difficult to distinguish from what you said and the quoted sources because the formatting looks similar. Did you say that there was planning or did you say that there was no planning?

@Omah

I said:

@Omah

Of course it wasn’t unexpected - there had been reports, planning and exercises to investigate the possibility of a pandemic - there had been at least 2 “true-to-life” movies which ‘predicted a pandemic’.

Nevertheless, the current government failed to learn the lessons from the reports, planning and exercises

I said “there had been reports, planning and exercises to investigate the possibility of a pandemic …
the current government failed to learn the lessons from the reports, planning and exercises”

[AnnieS]

So there was planning? Was any of the planning beneficial? Did we start from zero or was there an infrastructure in place that enabled us to generate a response to the pandemic? NB your own view would be appreciated. I have a habit of only reading the first sentence of each paragraph. This comes from information overload at work.

[AnnieS]

@Omah

Further recommendations

The 22 further recommendations, listed as per the report, include:

So without referring back to the original text, can you tell me what number 14 is?

[Omah]

@AnnieS

a precis of this in your own words?

That is the precis.

[Omah]

@AnnieS

So there was planning? Was any of the planning beneficial? Did we start from zero or was there an infrastructure in place that enabled us to generate a response to the pandemic? NB your own view would be appreciated. I have a habit of only reading the first sentence of each paragraph. This comes from information overload at work.

I have no intention providing anything less than I have done.

[AnnieS]

@Omah

I have no intention providing anything less than I have done.

ok that is your choice.

[Omah]

@AnnieS

NB your own view would be appreciated. I have a habit of only reading the first sentence of each paragraph.

In a sentence:

@Omah

The UK is an “advanced” country which had prior warning of such a pandemic happening and the resources to plan for and deal with such a situation but, as COVID-19 took over the world, BJ and his Tory government, failed, successively, to deal with known events and the UK ended up with an appalling COVID-related death-toll.

[Omah]

@AnnieS

@Omah

I have no intention providing anything less than I have done.

ok that is your choice.

… and selective reading is yours.

[AnnieS]

@Omah

The UK is an “advanced” country which had prior warning of such a pandemic happening and the resources to plan for and deal with such a situation but, as COVID-19 took over the world, BJ and his Tory government, failed, successively, to deal with known events and the UK ended up with an appalling COVID-related death-toll.

OK but I can’t see how that answers my questions : So there was planning? Was any of the planning beneficial? Did we start from zero or was there an infrastructure in place that enabled us to generate a response to the pandemic?

[AnnieS]

@Omah

and selective reading is yours.

selective answers are mine too?

[Omah]

They will be if you only read the first sentences of a paragraph in a document.

[AnnieS]

*The first sentence of each paragraph - this only applies in the case of excessive information overload

[Omah]

However, getting back on-topic:

This report sets out the facts on:

• the government’s approach to risk management and emergency planning (Part One);
• the actions the government took to identify the risk of a pandemic like COVID-19 (Part Two);
• the actions the government took to prepare for a pandemic like COVID-19 (Part Three); and
• recent developments (Part Four).

The report sets out central government’s risk analysis, planning, and mitigation strategies prior to the arrival of the COVID-19 pandemic, with the aim of drawing out wider learning for the government’s overall risk management approach.

[Omah]

The report concludes:

20 This pandemic has exposed a vulnerability to whole-system emergencies – that is, emergencies that are so broad that they engage the entire system.

Although the government had plans for an influenza pandemic, it did not have detailed plans for many non-health consequences and some health consequences of a pandemic like COVID-19.

There were lessons from previous simulation exercises that were not fully implemented and would have helped prepare for a pandemic like COVID-19.

There was limited oversight and assurance of plans in place, and many pre-pandemic plans were not adequate.

In addition, there is variation in capacity, capability and maturity of risk management across government departments.