The Government’s assumption that a flu pandemic was the biggest health threat facing the UK made the NHS ‘less prepared than it otherwise would have been’ in tackling the Covid crisis, a report has said.
The joint report, by the Institute for Government and the Chartered Institute for Public Finance and Accountancy (CIPFA), found the Department of Health and Social Care’s (DHSC) assumption that flu posed the highest national risk impacted its decisions on which drugs and equipment it chose to include in Public Health England’s (PHE) pandemic stockpile, and where to build additional capacity.
The report highlighted comments made by Bill Morgan, former special adviser to former health secretary Andrew Lansley, who said: ‘The Government continued to rely on the assumption that the pandemic we had to worry about was a flu pandemic even though SARS and MERS were coronaviruses. This perhaps led us to take comfort in the antiviral stockpile [of drugs aimed at treating flu] a little too much’.
PHE’s PPE stockpile had been ‘designed for a flu pandemic’, and therefore did not contain fluid repellent gowns or visors, ‘which are of less importance with an influenza pandemic but vital for preventing coronavirus transmission’, the report said.
The PPE stock was also ‘small’ relative to the NHS’ needs early in the pandemic, and this was made worse by the fact that GP practices and other providers struggled to obtain the equipment through their normal channels, it added.
The report said: ‘One witness at the Health and Social Care Committee observed that PPE availability ‘is an issue less in hospitals and more in our ancillary services and in the primary care setting, where PPE is not being distributed quite as efficiently [i.e. quickly] as it could be’.
‘PHE packages for GP surgeries included gloves, masks and aprons but not goggles, despite its own guidance that GPs should have eye protection to prevent infections from droplets if they come within a metre of patients.’
The Government’s crisis planning also lacked sufficient preparation for a coronavirus pandemic, the report said, with ‘the possibility of ‘social distancing’ covered only briefly in the Government’s 2011 Influenza Pandemic Preparedness Strategy.
None of the public services assessed in the strategy were given ‘proper consideration’ as to how they would operate under social distancing rules, including how GPs would work from home, it added.
While the 2011 plan provided details on how to organise testing during a pandemic, the Government gave ‘insufficient thought’ to how testing arrangements would work for frontline staff, it said.
The report added that the Government has failed to learn lessons from its previous major pandemic planning exercise, Exercise Cygnus – a simulated flu outbreak in 2016 – and has not implemented key recommendations from it.
Funding and resources
The report concluded that ‘a better-funded health service, able to meet performance targets…in normal times, would have been in a better starting position’ to effectively deal with the pandemic.
Instead, the NHS in England entered this crisis missing all routine performance targets for access to care, with a particularly sharp decline since 2015, it said.
Coming into the pandemic, general practice had limited spare capacity and a large number of vacancies, meaning the sector lacked ‘preparedness and resilience’.
In their recommendations, the think tanks called on the Government to analyse the resilience of public services when making funding decisions in the 2020 spending review, including around staffing and equipment.
Also, while general practice implemented remote working ‘incredibly quickly’, this ‘was made possible by some software providers offering their services for free and NHS England funding for IT hardware,’ the report said.
‘If the Government expects GPs to offer more remote services, they will have to provide GPs with the funding to cover the ongoing running costs of this technology,’ it added.