Aug. 15, 2020. “Analysis: Whitehall’s systemic failure exposed – why this was a disaster ten years in the making,” UK Telegraph, Paul Nuka
“When the UK Government finally got around to publishing its Covid-19 exit strategy in May, one paragraph above all others signalled radical change for Britain’s public health establishment. Under the heading “Sustainable government structures”, the authors noted that as the Government fought Covid-19 it would “learn the right lessons from this crisis and act now to ensure that governmental structures are fit to cope with a future epidemic”.
“This will require a rapid re-engineering of government’s structures and institutions to deal with this historic emergency and also build new long-term foundations for the UK,” they added.
Three months later and the game to determine the future shape of Whitehall is in full swing. Mark Sedwill, Cabinet Secretary and Britain’s most senior civil servant, has been dismissed for a duck, clearing the way for those Conservative ministers, MPs and aides best known for their “strategic vision” to step up to the crease.
Meanwhile, at the boundary and in the slips, permanent secretaries and assorted mandarins are playing the long game and aiming for “management and efficiency” tweaks rather than anything resembling the last great structural shake-up of the Civil Service that followed the First World War and the Spanish flu pandemic of 1918….
So what are the lessons of this ongoing crisis and what reforms might be expected?
While virtually all independent experts say it will take years for the dust to settle, the knives are already out for Public Health England (PHE), the executive agency of the Department of Health and Social Care….
Iain Duncan Smith MP, the former Conservative Party leader and the brains behind Universal Credit, has said he would “abolish PHE tomorrow” if he was in charge, accusing the agency of “arrogance laced with incompetence.”
Others say the agency’s responsibilities are too broad, covering everything from infectious diseases to sexual health. Matthew Lesh, head of research at the Adam Smith Institute, is one of several calling for PHE’s responsibilities in the area of infectious diseases to be hived off into a dedicated agency-a UK centres for disease control or, as government sources propose today, a new National Institute for Health Protection.
Nick Davies, programme director at the Institute of Government, agreed PHE’s duties may be too broad. “I guess there are reasonable questions about whether campaigns to reduce smoking should sit with infectious disease control,” he said….
“I think it’s fair to say the crisis hasn’t exactly been a good advert for what happens for services directly under government control. If you look at, for example, NHS test and trace – directly under the control of ministers – that’s clearly been a bit of a disaster.”…
There can be little doubt Britain’s poor response to the pandemic will ultimately be explained by group think: a fatalistic and inflexible approach to pandemic planning that seduced not just Whitehall but much of Britain’s scientific establishment.
Today it is best seen in the excuse proffered by almost any minister, civil servant or government scientist you challenge about Britain’s response to the pandemic: that all would be have been well had we been hit by pandemic flu rather than a coronavirus.
Britain had a first-class influenza pandemic strategy – second in the world after the US for its preparedness–and would have performed well had it been another Spanish flu, so the argument goes. [“There would have been nothing much to do, other than bury the dead."]
There would have been no demand for masks, visors or droplet repellent PPE. Mass testing and track and trace systems would have been next to worthless. And there would have been no need for lockdown.
Why? Because an influenza pandemic would have been unstoppable. Just as was shown by Excercise Cygnus in 2016 when ministers simulated a flu pandemic, many tens of thousands would have died but there would have been nothing much to do, other than bury the dead.
This is the narrative pushed by Jeremy Hunt, the former Health Secretary, and Sally Davies, the former chief medical officer, who were responsible for Britain’s pandemic planning, but it will never survive the scrutiny of the public inquiry to come.
As epidemiologists like Prof Francois Balloux, director of the Genetics Institute at University College London, have pointed out, past pandemic strains of influenza and SARS-CoV-2 are extraordinarily similar. Both are droplet spread, if anything Covid spreads faster than influenza, both cause asymptomatic infections and both have similar infection fatality rates.
“SARS-CoV-2 behaves in most ways like a pandemic influenza strain,” wrote Prof Balloux in a recent Twitter thread. “The only major epidemiological difference between COVID 19 and flu pandemics is the age risk distribution, with influenza being highly dangerous to young children in addition to the elderly. At this stage, COVID 19 is really ‘like pandemic flu’, but not like ‘seasonal endemic flu’ [which is much less lethal]”….
Added: Citation re Covid vs children: Unlike Covid, the flu is highly dangerous for young children:
Per “epidemiologists like Prof. Francois Balloux, director of the Genetics Institute at University College London...“The only major epidemiological difference between COVID 19 and flu pandemics is the age risk distribution, with influenza being highly dangerous to young children in addition to the elderly.””
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Added: UK decides to overhaul its public health system, will create National Institute for Health Protection, modelled on Germany’s Robert Koch Institute:
Aug. 15, 2020, “Hancock axes ‘failing’ Public Health England," UK Telegraph, Christopher Hope
“PHE to be scrapped this week and replaced by German-style pandemic response agency.”
“Public Health England (PHE) is to be scrapped and replaced by a new body specifically designed to protect the country against a pandemic by early next month, the Telegraph can disclose.
Health Secretary Matt Hancock will this week announce a merger of the pandemic response work of PHE with NHS Test and Trace into a new body, called the National Institute for Health Protection, modelled on Germany’s Robert Koch Institute.
The Health Secretary, who returns to work after a UK holiday this week, wants to give PHE’s replacement time to be set up before a feared surge in coronavirus cases this autumn.
It comes weeks after Boris Johnson, the Prime Minister, complained that the country’s response to the pandemic had been sluggish, in remarks which were interpreted as a swipe at PHE.
A senior minister told the Telegraph: “We want to bring together the science and the scale in one new body so we can do all we can to stop a second coronavirus spike this autumn.
“The National Institute for Health Protection’s goal will be simple: to ensure that Britain is one of the best equipped countries in the world to fight the pandemic.”
The institute’s new chief executive will report both to ministers at the Department of Health and Social Care, and to Professor Chris Whitty, England’s Chief Medical Officer, giving ministers direct control over its response to pandemics.
Mr Hancock is seeking someone with experience of both health policy and the private sector to run it. Baroness Harding, the former chief executive of TalkTalk who heads up NHS Test and Trace, is tipped for the role.
The change will be “effective” within the next month but it will take until the spring to formally complete the organisational change of breaking up a large organisation.
A source said: “It will be in place by September.”
Sir Iain Duncan Smith, a former Tory Cabinet minister, welcomed the news, saying: “The one thing consistent about Public Health England is that almost everything it has touched has failed.”
The new institute – which will have tens of thousands of staff – will bring together the science expertise at PHE, which first published the genome of Covid-19, with the scale of NHS Test and Trace operation.
The model for the new institute is the Robert Koch Institute in Germany. The independent agency played a central role in the response to the Covid-19 pandemic, publishing daily situation reports that log new outbreaks, testing capacity and the current burden on the health system.
Approaches to tackling the crisis in South Korea have also provided evidence for Health officials in setting up the new body. Over the next few months Test and Trace call centres will be wound down and replaced by local teams run by councils which are seen to be more effective and persistent at tracking down cases.
PHE’s work on tackling obesity will be handed over to local councils and family doctors, who are being encouraged increasingly to intervene to encourage fat people to lose weight.
In the medium term, the Health and Safety Executive, under its new chairman former Conservative MP Sarah Newton, will get a bigger role in assisting companies in getting more staff back to work.
PHE was originally set up in 2013 by then-Health secretary Jeremy Hunt as a result of an NHS shake-up organised by his predecessor Andrew Lansley.
The unprecedented challenge of the pandemic has exposed its weaknesses. Mr Hancock, who has been working on the overhaul for three months, had to take control of the Government’s testing strategy from PHE in March to scale up the numbers quickly. One Government source said: “One of the many problems with PHE is that it has been spread too thin during the full pandemic.
“Instead of having an organisation that is constantly on alert for pandemics you have an organisation that has been concentrating on prevention of ill-health.”
There has also been a blame game in Whitehall with Health officials furious with PHE for counting all deaths from Covid-19, rather than just those within the first 28 days of contracting the virus, as in Scotland.
The body was also criticised for not having enough diagnostic testing capacity to properly track the progress of the epidemic in the early weeks of the outbreak.
Number 10 is understood to have become frustrated that PHE’s £190,000 a year chief executive Duncan Selbie, who is likely to be forced out under the changes, appeared reluctant to take a lead.
One source said he had rarely been seen in 10 Downing Street when the strategy was being set, despite the scale of the challenge facing the country, which the source said was “bizarre.”
However, in a statement to the Telegraph Mr Selbie said criticism of PHE over its handling of diagnostic testing was “based on a misunderstanding.”
He said: “The UK had no national diagnostic testing capabilities other than in the NHS at the outset of the pandemic. PHE does not do mass diagnostic testing.
“We operate national reference and research laboratories focussed on novel and dangerous pathogens, and it was never at any stage our role to set the national testing strategy for the coronavirus pandemic. This responsibility rested with DHSC.”
Asked if he saw merit in setting up a Centre for Disease Control (CDC) to tackle pandemics, Mr Selbie said: “PHE is already a dedicated CDC for infectious diseases and other hazards to health including chemicals and radiation. But we are not funded or scaled for a pandemic.
“PHE is currently working with the NHS and the Government to prepare for the challenges of the coming winter with an expanded flu vaccination programme and much improved data.
“The pandemic offers the opportunity to reset the balance between risk and investment and our focus is on getting this right.””
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