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Covid-19: Hancock tells inquiry of “doctrinal failure” over pandemic planning

BMJ 2023; 381 doi: (Published 27 June 2023) Cite this as: BMJ 2023;381:p1478
  1. Jacqui Wise
  1. Kent

The UK government’s pandemic planning followed a flawed doctrine of dealing with deaths rather than stopping the spread of the virus, the former health secretary Matt Hancock has admitted.

The country’s focus on planning for the consequences of a disaster, such as buying enough body bags or deciding where to bury dead people, was completely wrong, Hancock told the UK Covid-19 Inquiry on 27 June.1 “Central to planning should be how to stop the pandemic in the first place,” he said. He told the public inquiry that a consequence of this doctrinal failure was that large scale testing or contract tracing did not exist when it was needed and had to be built from scratch.

The first section of the inquiry is looking at how prepared and resilient the UK was before covid-19 hit. This meant that Hancock was not asked about the government’s response to the pandemic, including lockdowns, test and trace, and personal protective equipment (PPE), which will be covered in the second module of the inquiry in the autumn.

Asked why he had not changed the approach to pandemic planning, Hancock said that it was because he had been assured that the UK was among the best in the world. With hindsight, he said, he wished that he had spent time changing the mindset within his department.

He said he was told that influenza was “category 1,” as it was the most likely cause of a pandemic. But he told the inquiry that the focus on flu was not the central flaw of pandemic planning but rather the lack of focus on stopping the spread of a virus.

In earlier evidence to the inquiry the former prime minister David Cameron, former chancellor George Osborne, and former health secretary Jeremy Hunt all admitted that the government had made a mistake in focusing on preparing for a flu pandemic at the expense of other potential threats.2

Resources diverted by Brexit

Hancock was asked repeatedly about Exercise Cygnus, a 2016 cross government flu pandemic exercise strategy. The inquiry has seen evidence that only eight of the 22 recommendations made after the exercise had been fully dealt with by the time covid-19 hit. He confirmed that work streams to update the Exercise Cygnus document were paused because of a diversion of resources to prepare for the possibility of a no-deal Brexit.

But he said that the inquiry would be wrong to conclude that the UK’s response would have been that much better if every lesson from Exercise Cygnus had been implemented. “This is because Cygnus was flawed in its central assumption about how best to respond to a pandemic,” he said. To make way for Brexit planning, the cross government Pandemic Flu Readiness Board did not meet for a year between November 2018 and November 2019, said the inquiry’s barrister, Hugo Keith.

However, Hancock said that work on Brexit, including creating relationships with pharmaceutical suppliers and knowing more about medicine supply chains, had helped the UK to be better prepared. He said that the suppliers came “extremely close—within hours” of running out of medicines for intensive care and that the only reason they did not was because of work done in preparation for a no-deal Brexit.

Keith said that, unlike some eastern Asian countries, there had been a failure in the UK to think about countermeasures such as mandatory quarantining, shielding, and border controls.

Hancock agreed and said that he had had to over-rule the initial advice not to quarantine people coming in from Wuhan, China, as “it was madness.” He said that it was written into international health regulations that you should not close borders, and he said this was a World Health Organization problem, not just a UK problem.

He added that the government had started buying PPE in January 2020, long before it was certain that covid-19 would be a global pandemic, but that problems with its stockpiles were very significant. He said that it should be a legal requirement for health and social care settings to hold significant stocks of PPE to get through the early weeks of a future pandemic, as “the sheer logistical complexity of setting up supply chains in short order is exceptionally difficult.”

Hancock praised workers across health and social care during the pandemic, to which Keith said that they were “lions led by structural donkeys. Personally everyone gave their all, but the system was not fit for purpose, was it?” Hancock replied, “That’s absolutely right.”

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