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Ambitious rhetoric and appalling reality: the UK government’s response to covid-19

BMJ 2020; 369 doi: (Published 11 June 2020) Cite this as: BMJ 2020;369:m2321

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  1. Andy Cowper, editor
  1. Health Policy Insight, London, UK
  1. andycowper{at}

Just who is in charge, Andy Cowper wonders

Prime Minister Boris Johnson set out an ambition to establish a “world class” test and trace scheme and has said he is “very proud” of the government’s response to the covid-19 pandemic. On 27 April 2020, in a speech in Downing Street, he even said, “I know that there will be many people looking now at our apparent success.”1

Yet there is a stark gap between this ambitious rhetoric and the appalling reality of how the government has dealt with the pandemic. The UK has one 10th of the world’s deaths from confirmed covid-19,2 with only the US recording a higher absolute number of deaths. If we account for population size, the UK is third in the world, with only Belgium and Spain in higher places.

Even the government’s presentation of data on its performance has been woeful, especially when it comes to testing. Sky News’s economics editor, Ed Conway, found that the figures on the numbers of tests carried out have been bulked up to hit the government’s target of 100 000 tests a day by including the number of testing kits posted out,3 and it is wholly unclear whether there are any good systems for counting their return.

The Telegraph has found that 30 000 people will need retesting, as errors in US laboratories mean that 40% of swabs sent there for analysis did not give reliable results.4 And in mid-May the Health Service Journal reported on internal NHS emails showing that commercial laboratories testing for covid-19 were not providing data to local NHS and councils.5

Channel 4 News received leaked data showing that, in the opening few days of the test and trace programme, the scheme had received details of 4456 confirmed cases and 4634 contacts but had approached only 1749 of these contacts.6 This is a contact rate of around 40%, yet England’s health and social care secretary, Matt Hancock, described the launch of the programme as “successful.”

The chief executive of the UK Statistics Authority made clear his frustration at the inadequacies of the government’s covid-19 testing data in an excoriating letter to Hancock.7 The way “the data are analysed and presented currently gives them limited value” for understanding the epidemic, he wrote. “The aim seems to be to show the largest possible number of tests, even at the expense of understanding.” I recommend reading this letter in full: it is a staggeringly strong public rebuke to a cabinet minister.

The publication of other official data and analyses has also been beset by problems and delays. At the time of writing, the last dataset on covid-19 deaths in care homes is more than three weeks old.8 And Public Health England’s report on how covid-19 disproportionately affects ethnic minority communities was, HSJ has found, censored by Hancock’s office before its publication.910

Other important data are not merely mis-presented: they are simply not available. The chair of the House of Commons Health Committee, Jeremy Hunt, was unable to hide his incredulity at the responses given to a recent committee hearing by Dido Harding, the chair of NHS Improvement, who is now also national covid-19 test and trace lead.

Harding could not provide numbers on how many people had been contacted by the new national track and trace programme, nor how many covid-19 test results overall were returned within 24 hours, as recommended by the government’s Scientific Advisory Group for Emergencies (SAGE).11 This was despite Hunt having informed Harding in advance of the questions he would ask her.

At a time of a global respiratory pandemic for which no effective vaccine yet exists, the bare minimum that a nation, and its health system, needs from its government is two things: competence and trustworthiness. It feels surreal to be writing these words on the influences of communications and politics on the UK’s response to covid-19, but the need to do so is a signal of the poverty of our government’s performance that has shown so starkly the gap between their ambitious rhetoric and the appalling reality.

What is the public’s view of the government’s response? Recent polling by Ipsos MORI shows that 62% of UK respondents believe we should wait at least a few more weeks before reopening businesses, to reduce the risks of contracting covid-19.12 And YouGov’s weekly tracker polling finds that the government’s popularity has been hit hard in recent weeks, almost certainly by its conduct over covid-19.13

On 2 June 2020 the Telegraph reported as an “exclusive” the fact that Johnson was “taking back control” of the government’s response to the pandemic.14 We may well wonder, as opposition leader Keir Starmer did at prime minister’s questions, who has been in charge of it all thus far.


  • Competing interests: None declared.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

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