Living in a COVID World: A Long-term Approach to Resilience and Wellbeing (COVID-19 Committee Report)

Lord Alderdice Excerpts

Wednesday 29th November 2023 Grand Committee

[Lord Alderdice (LD)]

My Lords, I will say a word of appreciation on my and the whole committee’s behalf to our chair, who went to enormous lengths to try to make sure that we had the resources, time and staff that we needed. As she has done, I thank them as well. This was not an easy time to produce a substantial report. All of us, the country as a whole and the world community faced all sorts of challenges, but I think we produced something that will be useful, as long as we take it and build on it.

We can learn lessons, but the question is whether we learn the right lessons. A couple of days ago, my wife was talking to a friend in our local village, who realised that she probably had Covid. She did a test and the two red stripes came up, so it was absolutely clear. She then said, “What are the rules for what I do?” As a doctor, I would say that in a situation like this the question is not what the rules are but how you do the right thing for your health and that of those around you. If you have Covid, it is absolutely clear: keep yourself away from others, to protect yourself and them. However, the lesson that this friend had learned from the experience of Covid was not that we should take those reasonable precautions but that we should check out the Government’s current rules. Of course, there are no rules at the moment, because they have understandably left that to the side. For me, the importance of that experience was that we must learn not just lessons but the right lessons, as we might end up learning not necessarily the right ones.

One problem with the way we think in situations of existential threat is that we do not weigh up cost-benefit analysis. The parts of your brain that you use in situations of relative stability—quite literally; you can do fMRI studies of this—are those that weigh up cost and benefit, but the parts that you use when under existential threat operate on the basis of rules that you have previously imbibed. They may or may not be suitable to the situation you are in and the challenges you face. This was one of the many problems we faced in this situation that we could generalise to other situations, including current situations of violence and war. In such circumstances, people do not necessarily weigh up the wisest things to do; they react off how they feel and the rules that they have learned previously.

These changes and challenges are a real problem for the way that we govern. For example, there are some suggestions in our report that we should have more devolution in how we operate. As a good liberal, I entirely agree with that proposition, but I do not agree that that solves all the problems or that it is the only thing.

There are many problems in your Lordships’ House occasioned not just by Covid but by some other developments—for example, the development of digital. The speed with which these changes are taking place is something our whole legislative process simply cannot keep up with. If you begin to develop an idea to address some kind of problem with new technology, then you put out a discussion paper, produce some consultations and then start taking it through the parliamentary process and eventually start putting in some regulations, by the time you have done all of that it has all moved on to another problem. There are very real problems with the whole structure and way we operate and govern. We need to find some way of addressing that. This committee’s report adverts to it but does not study it in detail; it was not the committee to produce answers to those questions. If there is a place where those questions ought to be considered, it is in your Lordships’ House, and I hope we have an opportunity to do that.

There are some things that changed at the time quite remarkably and quickly, and for the better. Noble Lords will all recall that it took no time at all to get through a very thick Bill on Covid at the start, with all the things we had to do and make sure of. As we rushed through all of it—obviously there was a time imperative—I went to the clerk at the end of Third Reading and asked how long it was going to take us to get Royal Assent. He said, “Oh, about half an hour”, and I said “How is that possible? She”—because it was she then—“is out at Windsor Castle”. “Ah”, they said, “she’s agreed to sign it digitally”. I thought to myself, outside of Covid, how many decades of discussion it would have taken to do something like that. But Her Majesty simply decided—quite wisely and sensibly, as she often did—to just do it; she did it, and it was absolutely the right thing to do. There have been helpful advances during Covid that might not have happened or would not have happened so quickly had it not been for the exigencies of the circumstances. That was perhaps one of the more delightful examples.

There were some other examples that were not so encouraging and reassuring. There were some things we had to do at the time but have to find a way back from. I will refer to two medical papers and a book. The first is a paper published in the BMJ in 2021 about face-to-face GP consultations. It says:

“The latest NHS England letter to general practices states that face-to-face appointments should be offered at patient request, which is a U-turn on the previous policy of total virtual triage during the pandemic and”—


this is important—

“potentially conflates patient preference and clinical appropriateness”.

Sometimes the patient will want something that is not appropriate, or vice versa. Those two requirements were not reflected in the revised recommendation. In addition, it said that

“the rapid shift to physical closure of surgeries, digital appointments, and virtual or form-based online triage presented challenges for marginalised patient groups, who already face major barriers to accessing primary care”.

Some of you will have heard of a report from the BMJ, reported in various newspapers today, on how it is quite clear that there are major problems and disadvantages. People’s healthcare is not being as well addressed as it ought to be. I think any of us who have tried to make a GP appointment in many areas—not in every area; there is quite a variation—will know that you are having to wait up until midnight to go online because all the appointments are sorted before then. You then have to go through a completely inappropriate questionnaire on all sorts of things, which leads to completely the wrong outcome. We have to understand that some things had to be done in the emergency situation, but we also have to go back and look at them again in the light of the new circumstances and try to see if they are still appropriate—if ever they were.

It must be said that sometimes we have to pay particular attention to the individual requirements of a patient. A book was published shortly after all this called Psychoanalysis and Covidian Life, which I thought was a marvellous title. It had therapists from various parts of the world talking about their experience and their work. There was one very interesting chapter entitled “Where does the analyst live?”, where the psycho- analyst described how she

“continued her work with a very young autistic girl using mobile phones”,

which she would not necessarily have tried to do previously. This form of communication actually made clinical progress much more possible than face-to-face work, because of the nature of this girl’s disorder. It seemed a really interesting example of how real clinical advances actually were able to result from the challenges of Covidian life. So it is not all bad news—there have been positive and good things happening.

But there were also serious downsides, not least in terms of performance of government. For example, there were lots of strategies and papers produced well in advance of all this about all the kinds of things that we should have available—lots of PPE and lots of ways of operating and so on. The problem was that, when we were not in the middle of a pandemic, they were not actually done. They were all agreed and all on paper, and people had responsibilities for them, but they said, “The budget’s tight at the moment, and I just hope it doesn’t happen on my watch”. When eventually the problem did arise, all the strategies had been prepared but had not been implemented. So when we get a response from government that says that it has this plan, this plan and this plan, it is good to hear that there are plans, but it is not enough. How can we be confident that, faced with another pandemic, or one of the many other frightening circumstances that we are likely to face, things are actually in order and not just there on paper? To say “on paper” is a little bit old hat, really—“digitally available”, perhaps one should say.

In that regard, I want to speak to the Government’s response. I find it disappointing, on a number of fronts. To refer to a few of the recommendations, recommendation 5, for example, is about the problems of disinformation, misinformation and people being misled. Quite rightly, it points up that there are rules that need to be adhered to and developed, but nothing is said about the fact that leading public figures sometimes make misrepresentations that confuse people and create problems. There is nothing in it about how public figures need to be responsible in how they react to things. It is not just a question of rules.

In recommendations 7 and 9, we say that there is an importance to having some redundancy of provision in public services—in other words, that hospital beds are not 100% full, or even 98% full because, if you do that and something happens, you get all the problems that you have seen with people being unable to get into hospital because there is no built-in redundancy. I remember that, when my wife and I came into the health service and started working, we were talking with her father, who was a bank manager, and explained about the staffing system—that, at best, we would have 100% of the staff places filled. He said, “That’s crazy. In the bank, we have an extra 15% to 20% of staff, because you always know that some people will be off ill or off training, and some people will be doing other things”. I told him that we did not even have the 100%, never mind 120%. So there needs to be more built-in redundancy. The notion that the highest level of efficiency is making sure that there is absolutely nothing wasted means that, when it comes to a crisis, you have absolutely no possibility of addressing it properly. However, the Government’s response to the recommendation goes through all the things that the Cabinet Office says, and so on. I get the sense with that response, as with a lot of the others, that they were cut and pasted from some other document, because there is absolutely no reference at all to the specific recommendation for redundancy.

Then we come to the question of continuing professional development—for example in recommendations 19 and 20, where the report talks about

“preparing teachers and medical professionals to deliver online”.

So again, from somewhere or other, there are a number of paragraphs in response about the continuing professional development of teachers, but nothing about medical people and nothing about their development online. Again, it just looks as if something has been cut and pasted from somewhere else. This is really not the kind of response that we would hope to get to a report that we took quite a lot of time to prepare, and which many organisations from around the country contributed to.

There are some pieces of progress. The one I would refer to under recommendation 21 is the NHS app, which has been rather good and has made a lot of things available to people. It is, say the Government,

“a simple and secure way for people in England”—

it is quite true that it does not apply to everybody in the United Kingdom—

“to access a range of NHS services”.

People can look up their test results and make appointments, and so on. So that is an advance. It is not that I just want to be critical of everything; if there are areas of progress, let us recognise them and recommend them. However, let us just also understand that our NHS, on which we are so dependent, simply is not working at the moment, and we need to try to address that.

I have already taken up far more time than I ought to have. That is because we felt quite passionate about all this and therefore felt pretty disappointed when the response that we got back from government did not pay attention to the recommendations that we had made.