There has been much attention on the Covid‐19 Pandemic in this journal. For example, Paton focuses on the reasons for the UK's poor outcomes.
In an Editorial, Correia points out that much uncertainty still remains, and calls for prudence in public health emergencies, but argues that there are lessons to be learnt from what has happened so far.
There have been many other calls that we need to learn lessons from the Covid‐19 Pandemic, and there have already been many responses to those calls, with a rapidly developing ‘lessons industry’. As of October 2021, ‘Lessons AND Covid AND policy’ brings up about 4080 M hits on ‘Google’ and 769,000 hits on ‘Google Scholar’. Similarly, there have been many calls for an Inquiry to learn lessons, with some already set up. To give a few examples, in the UK there are ongoing Inquiries by a number of bodies including the Institute for Government, the Health Foundation, ‘The People's Inquiry’, the National Audit Office, and Parliamentary Committees such as Health and Social Care, Public Accounts, Public Administration and Constitutional Affairs, and Science and Technology.While there are many different types of Inquiry,
most calls seem to have the ‘gold standard’ (or perhaps, given the costs associated with Inquiries, gold‐plated) full Public Inquiry in mind. The government has agreed to an Inquiry, but has indicated that it will not start until April 2022. This suggests that we cannot expect the Inquiry Report any time soon, and any recommendations would be linked with learning ‘inter‐crisis’ rather than ‘intra‐crisis’ lessons, ready for the next Pandemic (compare
). However, as the next Pandemic may be different, this may result in the military adage of fighting the last rather than the next war.While Inquiries have different purposes, perhaps the most important purpose involves learning. A widespread view exists that the public inquiry is an ineffective means of lesson‐learning, but this has been challenged.
There are two broad perspectives of exploring what the UK might learn from an Inquiry. First, the broad extent of learning from NHS Inquiries does not look promising. Many NHS Inquiries in recent years have pointed to some similar themes, suggesting that lessons from Inquiries are not learned. It is important that recommendations must be implementable and implemented. However, in a version of Groundhog Day it is stated that ‘lessons will be learned’ but it is clear that this has not always been the case. In evidence to the Mid Staffordshire Inquiry in 2011, Sir Ian Kennedy (chair of the 2001 Inquiry Report into the Bristol Royal Infirmary) noted that most Inquiry Reports ‘have been consigned to gather dust on shelves’. He continued that unlike other industries, health care and the NHS does not appear to learn lessons: ‘there is something in the NHS that militates against recommendations like this entering the DNA of an organisation.’Second, we can examine whether lessons from the last ‘Pandemic Inquiry’
were useful for the response to Covid‐19. In 2009, Dame Deidre Hine (former, Chief Medical Officer for Wales) was asked to review the appropriateness and effectiveness of the UK strategy for responding domestically to the H1N1 [‘Swine Flu’] pandemic, and to make recommendations to update and refine planning for any future influenza pandemic (my emphasis). The main conclusion was that ‘overall, the UK response was highly satisfactory’ (p. 10), but in order to further improve future response, the review produced 28 recommendations. However, the relevance of the recommendations for Pandemics other than Influenza are unclear. The UK made extensive ‘paper plans’ for Pandemic Influenza, with the Covid Action Plan of March 2020
being partly cut and pasted from them. However, former Health Secretary Jeremy Hunt stated that the UK was prepared for the wrong pandemic by believing the next biggest threat would come from flu.
The verdict that the USA and the UK were the best prepared nations in the world according to the ‘Global Health Security Index’ turned out to be a cruel irony. Planning exercises suggest that the UK was not well prepared. Much of the focus has been on Exercise Cygnus in 2016 that focused on Pandemic Influenza. It reported 22 findings, including that by week seven the NHS was ‘about to fall over’; insufficient supplies of PPE; and glaring issues with virus testing capacity. In June 2021 (then) Health Secretary Matt Hancock stated that the Government response to Covid‐19 was based on Exercise Cygnus: all the preparations and the plans that were in place were for a flu pandemic. The UK carried out 11 Pandemic planning exercises between 2015 and 2019, including ‘Exercise Alice’ on MERS, another type of Coronavirus in 2016. Hancock stated that countries that experienced SARS and MERS were better prepared than we were, partly because of that experience, but that Covid‐19 is very different from SARS and MERS, with the most important difference being asymptomatic transmission.It is clear that there can be learning after a crisis, such as Korea after MERS,
and it may be possible to increase learning from Inquiries.
However, given the UK context and track record, those expecting useful lessons to emerge from a UK inquiry should be reminded of the Einstein definition of madness: doing the same thing and expecting different results.