Initial lessons from the government’s response to the COVID-19 pandemic Contents

Conclusions and recommendations

1.We remain seriously concerned by the extent of PPE supply that is not fit for purpose. The Department of Health & Social Care (the Department) has ordered 32 billion items of personal protective equipment (PPE) at a cost of approximately £15 billion. As of 7 June 2021, 2.1 billion items of PPE had not passed the initial quality assurance for use in medical settings, representing 6.8% of the items purchased. This is over five times more than the estimate of the amount of PPE which was unfit for purpose that the Department provided to us in January 2021. The Department has committed to ensuring that it makes the best use of the large number of items which are unsuitable for medical settings, but we are concerned that its planning on how to repurpose them is not yet complete. Storing its central stock of PPE currently costs the Department approximately £6.7 million a week, down from £11.7 million a week in January 2021.

Recommendation: The Department should update us with the following data on a quarterly basis:

2.Government’s ability to make well-informed decisions and address issues as they arise during the pandemic has been hampered by slow progress in addressing longstanding issues with data and legacy IT. We have repeatedly highlighted longstanding data issues within government, including the lack of data standards, ageing IT systems, fragmented leadership, and a culture that does not support sharing data across departmental boundaries. These issues came to a head during the pandemic. For instance, missing or inaccurate telephone numbers within NHS patient records meant that the shielding programme was unable to follow-up letters to 375,000 vulnerable people with phone calls. Similarly, local government lacked access to key information from NHS Test and Trace and public health officials lacked timely information on tests conducted in privately-run sites, hindering their ability to understand and manage outbreaks within their communities. HM Treasury and the Cabinet Office recognise that a key lesson from the pandemic has been the need to improve the quality of data available and assert that. investing in data and dealing with legacy IT issues is high on their priority list.

Recommendation: HM Treasury and the Cabinet Office should write to us by 31 October 2021 setting out how they plan to reflect the need to address data and IT issues when prioritising bids for the next spending review. The Cabinet Office should also provide us with a list of its ongoing projects aimed at improving the quality and interoperability of the data available to government by 31 October 2021, detailing goals, target dates and progress for each project.

3.Government risks undermining public trust and accountability for the pandemic response because of departments’ repeated failure to provide a full rationale for key decisions. We recognise that the pandemic has required departments to work at speed in difficult circumstances. But, as we have found in our previous examinations of the response to the pandemic, proper record keeping of how decisions are made and by whom is key for public confidence and to demonstrate value for money for the taxpayer. A key element of this is being transparent about the data on which decisions are made, the assumptions which have been used, and the uncertainty and limitations of the data used. Yet, government has often failed to publish full cost-benefit analyses or the data and statistics that it cites as evidence for key policy decisions. Government has also failed to publish the details of contracts awarded during the pandemic in a timely fashion. Of the 1,644 contracts awarded across government up to the end of July 2020 with a value over £25,000, 75% were not published within the 90-day target. This risks negatively affecting public perception of government’s openness and accountability for public money. Most of the contracts awarded up to the end of July 2020 were awarded by the Department and its national bodies.

Recommendation: The Department should update us by 31 October 2021 on the number of contracts awarded during the pandemic that are yet to be published.

4.A lack of clarity, timeliness and the volume of government communications has, at times, hindered the public’s understanding of guidelines and ability to comply with them. Government published a large amount of guidance during the early stages of the pandemic. Some departments, for example HM Revenue & Customs, developed effective, clear and consistent communications and engagement plans for initiatives such as employment support schemes. Communications from other areas of government were not always clear or timely. The Department for Education alone published 148 new guidance documents or updates to existing materials between 16 March and 1 May 2020. Guidance was often published at the end of the week or late in the evening, putting schools under additional pressure, especially when guidance was for immediate implementation. Stakeholders have identified a wide range of language-related issues in government’s official communications, ranging from complex use of vocabulary and grammar to vague references and inaccurate information. Some intended recipients may have also been excluded from communications. Government communications have focused on medical data far more than on the social and economic consequences of the pandemic, potentially limiting the public’s ability to form a complete picture of the pandemic’s impact. Announcements surrounding restrictions in Bolton and Blackburn on the 14 May indicate that communication errors are still taking place.

Recommendation: The Cabinet Office should write to us by 31 October 2021, setting out what lessons it has learnt regarding communicating with the public and stakeholders and what guidelines or procedures it has implemented to minimise issues concerning the volume, clarity and timeliness of communications.

5.Government has yet to improve its approach to managing risk or set out which trade-offs it intends to make in future emergencies. The pandemic has highlighted the importance of carrying out robust risk planning and being clear about risk appetite and risk tolerance. Government lacked pre-existing plans for many aspects of its response such as employment support schemes, support for people shielding and disruption to schooling. In the interests of speed, government took decisions which it recognised would lead to an increased risk of fraud and error, including relaxing some controls and streamlining spending approvals. The estimated financial consequences of this are large. Between £2.1 billion and £4.2 billion of employment support payments may be due to fraud and error. Similarly, between £16 billion and £27 billion in loans from the Bounce Back Loans scheme may not be repaid. Government’s decisions on imposing or easing restrictions involve considering a wide range of factors, including health risks with, social and economic risks, yet government has lacked a formal process to balance these risks and decide which trade-offs to make. Government has acknowledged that it needs to strengthen its management of cross-cutting risks and has accepted a recommendation, from the Boardman review, that it establish a cross-department risk management profession and training programme for risk managers.

Recommendation: The Cabinet Office should, by 31 October 2021, write to us detailing how, and when, it will implement the Boardman review’s recommendation to establish a risk management profession and training programme and provide us with a quarterly progress update until this has been fully implemented.

6.Government needs to do more to support the health and social care workforce, who have been under constant pressure during the pandemic, to ensure its resilience going forward. The pandemic has compounded pre-existing challenges in the health and social care sectors. In February 2020, the NHS had about 40,000 nursing vacancies and 9,000 vacancies for medical staff, while patient waiting times were continuing to slip and the number of patients on waiting lists for non-urgent treatment was rising. Longstanding staffing issues and backlogs, arising from failures in workforce planning and recruitment, have exacerbated the impact of the pandemic not only on the public, but also on the health workforce. NHS and frontline workers, already under pressure before the pandemic, have had to deal with the mental and physical strain of the response and are now tackling backlogs whilst carrying high numbers of vacancies. The NHS estimated in December 2020 that it had nearly 89,000 full-time equivalent vacancies across secondary care settings in England. We are concerned about the impact of the pandemic on the mental health of key workers and burnout levels, which may result in more individuals leaving the medical profession and even higher vacancies rates going forward. This makes the publication of the long overdue NHS People Plan even more urgent.

Recommendation: The Department should write to us by 31 October 2021 setting out what it is doing to provide mental health and emotional support to NHS staff, what metrics it is using to track the effectiveness of the measures adopted, and how it is performing against those metrics. It should also write to us by 31 December 2021 to provide an update on the substantive long-term NHS workforce plan to ensure the resilience of the health and social care workforce.

Published: 25 July 2021 Site information    Accessibility statement