Acute hospital consultant David Oliver considers how the Boris Johnson administration has constantly undermined its own plans to tackle COVID-19

Working as an acute hospital doctor throughout the pandemic, I’ve seen what COVID-19 can do to patients and colleagues and how clinicians and managers in local frontline roles have stepped up to re-organise services at pace, putting their own wellbeing on the line. 

I’ve also witnessed a series of failings in policy responses from the Government and its agencies, compounded at every turn by serial shortcomings in communication – by turn inept, economical with the truth and un-coordinated. This makes our jobs harder and destroys the trust of the public and professional workforce at a time when this is crucial.

Let’s start with those famous slogans. ‘Hands, face, space’ is a crisp steer for public behaviour, but some of the other components including ‘stay alert’, ‘control the virus’, ‘save lives’ and ‘protect the NHS’ seemed confused and vague – and in the latter case contributed to people not seeking care when they should have. 

Rules and instructions over which groups should shield and how, or the size of groups or support bubbles, curfews and allowed or forbidden activities, and mask-wearing have also caused endless confusion, with ministers themselves often being unable to explain them accurately in interviews.  

People absolutely understand that, as a public health crisis evolves and new evidence emerges, governments may have to change tack, but ministers have never satisfactorily explained the scientific advice or rationale leading to those changes. If people are told openly and on the level the reasons for certain decisions being made, then there is a chance you can take them with you. But this hasn’t happened.

On some occasions, it has emerged that political decisions flew in the face of the advice from the Government’s Scientific Advisory Group for Emergencies (SAGE) and other scientific advisors – for instance the timing of October’s lockdowns when SAGE had advised a ‘circuit breaker’ weeks before. It also took far too long for SAGE’s deliberations and membership to be put into the public domain and was done only following pressure.

The Data, Testing and PPE

From from the outset, the Government could and should have published all data on infection rates, COVID-19 mortality, other causes of health service utilisation and bed numbers to independent bodies such as the Office for National Statistics (ONS) and the National Audit Office. 

The daily Downing Street briefings started by presenting data only on deaths in hospital for people with positive COVID-19 tests, with the Government having to be pushed to present the ONS data on deaths outside of hospitals in settings including care homes and deaths which have COVID-19 recorded on death certificates, whether the person had a COVID-19 test or not. There have been further shifts in definitions of COVID-19 deaths even though doctors writing certificates are bound by clear responsibilities and have no control over data aggregation and presentation. 

But this led to avoidable rumours about whether COVID-19 deaths were being exaggerated or played down and resulted in the professional integrity of doctors questioned.

Then there were the near meaningless numbers pumped out on Coronavirus testing. Britain went into the pandemic with so little testing capacity that it struggled to obtain them even for sick hospital patients, let alone those at home or in care homes, or staff.  

The testing numbers have increased by multiples since March. Even now, there is no coherent strategy or operational approach to ‘test, track and trace’ of the type used successfully in several south-east Asian nations or elsewhere in Europe such as Germany. Yet, the Health and Social Care Secretary Hancock turned the whole endeavour into some kind of macho contest in which he could brag about test numbers for the sake of it – without actually defining testing’s purpose. In any case, what does it matter about how many tests there are if people consistently struggle to access them?

A similar ritual played out when it came to the provision of personal protective equipment (PPE) for staff, with the Government claiming big numbers and plane-loads. However, this was no comfort to those doing dangerous work on the frontline who could not access it. The insult was compounded by reports of clinical staff being disciplined for speaking out about their concerns and the downgrading in April of the pandemic’s severity by Public Health England – allowing it to recommend lower levels of PPE for staff.

Censorship and Impunity

A suppressive news management and message control effort from the Government and its agencies made NHS trusts fearful of saying much, with pressure transmitting down to their staff.

Journalists complained – as they still are regarding hospital activity data in Manchester and Merseyside – of poor access to any one who is willing to talk on the record. In such an atmosphere, unhelpful rumours and investigative exposés thrive. Why, for instance, did the Government have to be pushed and dragged screaming into releasing data on the number of frontline staff who had died from COVID-19?

But then there has been little transparency generally. This has included on the awarding of public contracts for testing and track and trace to companies, despite a number of them having an insufficient background in the area.

The comms operations has also compromised senior doctors and nurses working in governmental and non-departmental body roles by putting them up front and centre as human shields to lend credibility and ballast to ministers, finding themselves unable to challenge misleading statements and speak out freely due to the Civil Service Code. There should have been clarity from the outset that accountability for decisions lies with ministers and that advisors merely advise. The Government’s oft-repeated mantra that is was “following the science” was a distortion.

Perhaps the most egregious failure, however, was those in charge flouting the rules. The actions of both the Housing Secretary Robert Jenrick and the Prime Minister’s chief advisor Dominic Cummings undermined public trust around the lockdown. The co-ordinated defence of Cummings in particular by the majority of the Cabinet coincided with changes in public adherence to distancing and travel rules, as reported by a Lancet medical journal study in August. 

Unfortunately, I don’t see any relief from this catalogue of errors coming any time soon.

David Oliver is an experienced NHS acute hospital consultant who has treated patients with COVID-19. He has undertaken a variety of national professional leadership, academic, policy and governmental roles and writes a weekly column in the ‘British Medical Journal’


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