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Covid-19: UK government response was overcentralised and poorly communicated, say peers

BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4445 (Published 13 November 2020) Cite this as: BMJ 2020;371:m4445

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  1. Clare Dyer
  1. The BMJ

The UK government’s response to the covid-19 pandemic was “hampered by overcentralised, poorly coordinated, and poorly communicated” policies and the sidelining of local providers, a House of Lords committee has concluded.1

The pandemic, which saw thousands of older and disabled people die in residential care homes, “accentuated systemic frailties” in the care sector, said the Lords public services committee. The peers called on the government to commit at the earliest opportunity to an interim sustainable funding settlement for adult social care, and to publish its long awaited white paper on the sector “as a matter of urgency.”

In the first comprehensive analysis of how public services responded to the pandemic, the committee said years of underfunding left local services ill equipped to cope and “fundamental weaknesses” must be tackled to make services resilient enough to withstand future crises. The government has promised a public inquiry into its response to the crisis, but it declined to give oral evidence to the Lords committee and its offer to give written evidence arrived too late, the report said.

Committee chairwoman Hilary Armstrong said, “There should be no return to the pre-covid-19 status quo. The fight against health inequality should be a priority for the government.

“The government’s own pandemic planning identified that social care would need significant support during an outbreak of a disease like covid-19, yet social care was the poor relation to the NHS when it came to funding during lockdown. Discharging people from hospital into care settings without testing and with inadequate personal protective equipment led to the loss of thousands of older and disabled people.”

The report said that many deaths from covid-19 could have been avoided if preventative public health services had been better funded. Death rates were higher among those with avoidable health conditions, which are more prevalent in deprived communities.

The peers called on the government to recognise “the vital role of preventative public services in reducing deep and ongoing inequalities exacerbated by covid-19” and to introduce “a race equality strategy that would apply across public services to tackle health, care, and educational inequalities.” Death rates were higher among black and other ethnic minority groups which “suffered disproportionately because of health inequalities and unequal access to services,” they noted.

Also hit harder were children, with hundreds of thousands of “invisible” youngsters falling through gaps between social and education services across England, the peers said. Only one in 10 of those defined as vulnerable went to school or early years education during lockdown, and there was “not enough support for prevention and early intervention services.”

The BMA’s chair of council Chaand Nagpaul said, “The covid-19 pandemic has both exposed and worsened the inequalities that have shamed us for too long. We need a renewed focus on preventative health, better provision of local services providing accessible healthcare and advice to all communities, and a ‘health in all policies’ approach where every government policy is designed with its potential impact on health and wellbeing in mind.

“While the NHS, local authorities, and social care services have demonstrated real innovation and tireless commitment to delivering for their communities, this good work will be lost unless we now see real investment to boost staffing levels and capacity, and an end to the excessive centralisation that holds back local expertise and starves community health and social care providers of resources.”

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