Healthy exercise

Philip Hunt on the government’s failure to heed its own 2016 warning on the UK’s lack of preparedness for a major pandemic

Part of the government’s uncertain response to the Covid-19 crisis has been blamed on its belief that the virus could be treated much like influenza with herd immunity the goal. It was not until March that this approach was rapidly changed, as fears of hundreds of thousands of deaths were predicted. 

Ironically, had the government taken more notice of its own Exercise Cygnus – a 2016 plan to test the UK’s preparedness and response to a pandemic influenza outbreak - it might have been much more ready for the dramatic change in strategy. Instead, the response has been characterised by missed opportunities and a failure to invest in Public Health England’s system, and scale up local NHS laboratories and their university partners, has led to many problems in testing that could have been avoided.

A similar criticism could be made of the Scottish government, whose Exercise Iris in 2018 showed up staff unease at the lack of clarity on PPE availability, training, and testing.

Exercise Cygnus involved government departments, Public Health England, NHS, and local government. Participants, including ministers and senior civil servants, worked to a scenario where the pandemic was at a peak affecting up to 50% of the population and which could cause between 200,000 and 400,000 excess deaths. The leaked report, which the government still refuses to publish, concluded that we were not sufficiently prepared to cope with the extreme demands of a pandemic and urged a critical review of our capability to respond. 

Unfortunately, that doesn’t seem to have happened in any systematic way. If it had, many of the problems arising in care homes could have been avoided.

A considerable amount of focus in Exercise Cygnus was on how the NHS would cope with a surge of patients. It was envisaged that quick decisions would need to be made on discharging them from hospital back home or to a care setting. Despite high expectations that the social care sector could be used to support this approach, remarkably little attention was paid to social care issues during the mock COBRA meetings or in the lead up to them. 

The report identified how staffing and physical capacity in the social care system could be expanded to cope with the excess demand of a pandemic. It was even suggested that spill-over capacity could be extended through placing contracts with large hotel chains and purchasing extra space in some care homes. Despite all of this, when the government published the hospital discharge service requirement on 19th March, care homes were ill prepared to receive infected patients from the NHS.

In short, the care sector was a long way down the chain of command – something illustrated by the lack of priority given to them in relation to PPE and testing. On the recording of deaths, meanwhile, the lack of reliable figures was telling; and many care homes felt deserted by the government. The Association of Directors of Adult Social Services has described the national handling of PPE for care workers as ‘shambolic’, with early drops of equipment ‘paltry’ and more recent deliveries ‘haphazard’.

Our health service is now going through a rapid planning process to increase capacity across the NHS, independent hospitals, and care homes in the event of further waves of the pandemic. A stark illustration of what should have happened after Exercise Cygnus and a damning indictment of the government’s approach to the crisis.

Lord Philip Hunt of Kings Heath is a Labour Peer and a former Health Minister. He tweets @LordPhilofBrum 

Published 8th June 2020

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