Covid inquiry: communication failures impeded the UK’s pandemic response

Recently, the first report of the UK Covid-19 Inquiry was published.1 The Association of Directors of Public Health (ADPH) were core participants in the first module, which focused on pandemic preparedness. We gave evidence on behalf of directors of public health across all the UK’s four countries and dependent territories.

The report concludes that the UK government and devolved administrations’ systems of emergency planning, preparedness, resilience, and response failed because of flawed and overly complex institutions, systems, and structures, and a failure to learn lessons from the past. It also found that there was too little involvement in the planning process of local bodies and officials, including directors of public health (DsPH).

As one of those DsPH, I was pleased to see that the inquiry team took heed of our collective evidence.2 The lack of communication between central government and those of us who are on the ground when dealing with local outbreaks must be tackled if we are to respond to future pandemics more effectively.

As the inquiry report states in chapter 2, “DsPH, the workforce and local government are in regular contact with the local population and therefore have an important role in communicating the needs of the local population to the institutions whose responsibility it is to prepare for and build resilience to whole-system civil emergencies.”1

As we are responsible for our local population’s health, we have information about rates of existing illness and disease, as well as a network of partnerships with individuals and organisations within communities that are ideally placed to support planning and ensure that advice is delivered in the right way to the right people.

The length of time it took to use local expertise and take into account existing health and social inequalities—information that DsPH had readily to hand—resulted in a “one size fits all” response. This was a response which we also now know had not been properly updated for nearly a decade.

DsPH are also highly skilled in responding to health protection emergencies. This expertise around interpreting data, identifying cases, and contact tracing is usually deployed as soon as local health protection issues arise, yet it wasn’t deployed with covid-19 until the spread was out of control. Data about the spread of a pandemic need to be made available to public health teams from the outset so that local needs can inform the national response.

As a result of not fully using local expertise, covid-19 transmission rates were higher than they might otherwise have been, contributing to a widening of the already unacceptable gap in outcomes between people living in different areas.

The report sets out in detail why this vital two-way communication failed—our infrastructure is far too complex and, as my predecessor Jim McManus told the inquiry, could be “tidied up” to be able to provide a more effective response to future pandemics, as well as better planning.

Meanwhile, as well as making our public health infrastructure more resilient, we need to improve our resilience to illness by improving our baseline health. Increasing numbers of people are living with largely avoidable health conditions, and we saw during covid-19 that those with pre-existing medical conditions were hit harder. This is likely to be the case in any future pandemic. We therefore need to work to prevent avoidable illness by regulating industries and products that are causing harm, and by creating environments where healthy food, drink, and leisure options are both affordable and accessible to all.

The new UK government has announced the reintroduction of the Tobacco and Vapes Bill,3 as well as the promise of legislation to restrict advertising and sales of unhealthy products. This is a positive step towards reducing health inequalities and, if passed, will help support the efforts of DsPH to introduce local measures that protect residents from harmful products such as cigarettes, fast food, fossil fuels, gambling, and alcohol—products that contribute to the soaring rates of largely preventable illness and disease.

At the same time, we need to develop healthier spaces for us to live, work, and relax in. Public health teams do this by collaborating with planners, architects, builders, our colleagues in transportation and education, and a range of others, because all aspects of our lives have an impact on our health.

However, improvements in infrastructure, legislative change that promotes good health, and the creation of healthier spaces cannot be effectively implemented without an adequately equipped workforce. Funding for public health, and for local government, have seen significant real-terms cuts over recent years, and, without sustainable funding, we can’t provide enough properly trained and resourced staff to effectively carry out the full range of public health roles or commission the invaluable services of voluntary and community organisations.

Covid-19 had a huge human cost; our health and social care services were put under overwhelming pressure, and our economy suffered significant losses. This cannot be allowed to happen again. So now, for those of us fortunate to have come through the pandemic relatively unscathed, we must honour the hundreds of thousands of people who died, and those that continue to experience the impact of covid-19, by making sure that we are better prepared for next time.