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

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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. 

  • 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.

Explore the framework >>


Stephen Lancashire

Southwark Pensioners Action Group
Comment date
07 May 2021

I support your call for a Public Enquiry but feel you should be doing more to cover the KONP People's Enquiry which is happening NOW. It is genrating an enormous amoiunt of material from witness testimonies which is teacjhing me a great deal about how the NHS is being further undermined as a public service and the threats of fragmentation and privatisation which have continued apace under Simon Stevens watch.


Medical Researcher,
Comment date
04 May 2021

The reason we have had a surprisingly worse mortality rate compared to European countries is because we did not shut our borders - something we could have done very quickly and effectively being an island nation.
Also contracts for important things worth billions (e.g. T&T) were given to totally inefficient companies, who outsourced them to even more inefficient companies to deliver. For example I received an email asking me to rate 'Taste and Trace'!! Sounds like an Essex based TV food programme.

John Puntis

Retired paediatrician,
Keep Our NHS Public
Comment date
03 May 2021

This framework is helpful in setting the scene for an official inquiry, however, it will be years before an inquiry can be completed. The government handling of the pandemic has been truly disastrous. Testimony to this is the 150,000 bodies piled up. Far from coming out of the blue and taking everyone by surprise, the government ignored the recommendations of pandemic preparedness exercises like Operation Cygnus, was blind to the information pouring out of China in the early phase of the pandemic, delayed lockdown with catastrophic consequences and has failed to implement standard public health measures or listen to public health experts. We still dont have an effective test and trace system (now crucial to keeping coronavirus under control), economic and other support to make isolation feasible for low paid workers, and money continues to be wasted through crony contracts and pointless projects like widespread lateral flow testing. A full public inquiry is needed as a matter of urgency; this is owed to all those bereaved as well as the rest of society. Keep Our NHS Public has been holding 'The People's Covid Inquiry' (see our website) to answer those questions the government dares not even ask. KONP welcomes The King's Fund adding its voice to the long list of organisations and individuals calling for an inquiry so that lessons can be learned.

Anita Mackenzie

Governor/patient research Champion.,
University Hospitals Sussex. NHS Foundation Trust
Comment date
30 April 2021

I have thought that although UK/ England have not had such a good result with the C19 Pandemic.
I have considered the size of our UK land mass to other E.U Countries.
This has led me to believe that we are saturated in population per land mass.
Germany. Spain, France are 2 thirds bigger in land mass, thus population will be more spread out.
Our population is also more obese, plus more suffer with long time medical ailments.
Heart. Diabetes. stroke. e.t.c.
I am my and many of my associate's are reasonably satisfied the way the Pandemic has been handled.
Being in mind that it hit like a bomb and no one knew what to do in the beginning.
I will also add that a great deal of our younger generation are in the mind that this is not really a pandemic, but a Government way of how to control the population. This is why many have not abide by the rules thus spreading with impunity

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