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Assessing England’s response to Covid-19: A framework

The Covid-19 pandemic has been a deep shock to the country, whether counted in terms of deaths and ill health, the damage to the economy and livelihoods, or in the deep disruption to daily life.

Covid-19 has also had a disproportionate impact on some communities, increasing and emphasising the inequalities that existed before the pandemic arrived. This combination of high number of deaths and deep inequalities will leave a long and difficult legacy.

At the current time, on some critical measures (particularly deaths) England compares poorly with similar countries. Although the full outcomes from the pandemic are not yet known as countries face further waves, in 2020, the UK had one of the highest rates of excess deaths in the world. Mistakes have been made and in a pandemic, mistakes cost lives.

Decisions to enter lockdown have consistently come late, with the government failing to learn from past mistakes or the experiences of other countries. The promised ‘protective ring’ around social care in the first wave was slow to materialise and often inadequate, a contributing factor to the 26,000 excess deaths among care home residents last year.

Yet on other measures, such as the speed of vaccine roll-out, England compares well. However, successes in pandemics can at times be less obviously visible – they are often a poorer outcome avoided (of more deaths, greater economic impact).

Learning the lessons from Covid-19 would allow England to better prepare for any future pandemic, but also to understand the general weaknesses and strengths of its health, care and public health systems. Given the wide-ranging nature of the pandemic and its impact on so much of so many people’s lives, health and the economy, a public inquiry to assess the response will be essential. Steps to establish such an inquiry should take place immediately, so the process for learning lessons and putting in place stronger preparations for future pandemics can begin.

An inquiry will need to make a judgement across the whole of the response, not just certain elements within. This framework helps to do this by setting out a structure to help untangle the complicated interactions between different elements of the response in England. It does not provide a judgement on each.  Each individual element can and must be subject to a deep investigation into the successes, failures and the lessons learnt but in doing so, those deep dives must recognise how each individual element was connected to others in creating the whole response.

The framework is broken down into five key inter-related elements.

Different elements of England's response to Covid-19: Intrinsic risk; Public health response; Health care system response; Measures in wider society; Adult social care response
  • The intrinsic risk to England, including its population demographics, health status, openness to international travel, and social structure. This would include, for example, the proportion of older people in the population and the rates of obesity and diabetes (two risk factors for the severity of illness with Covid-19).

  • The public health response, including rules over international travel, the timing and extent of lockdowns, and the measures put in place to support and enable compliance with these measures.

  • The health care system response, including the re-organisation of services to maximise acute hospital and critical care capacity, the clinical quality of care, services for non-covid-19 patients and the vaccination programme.

  • The adult social care response, including support to social care providers and users including provision of testing, personal protective equipment (PPE), and staff training.

  • Measures in the wider economy and society to manage the impact of the measures taken to combat Covid-19, including macro-economic and tax measures, education and employment.