Preparing for Extreme Risks (RARPC Report)

Baroness Brinton Excerpts

Thursday 12th January 2023 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I declare my interest as a vice-president of the Local Government Association and as vice-chair of the All-Party Group on Adult Social Care. I was also health spokesperson for my party from January 2020, when my leader said that there was not much on the health agenda, and I retired from that post at Christmas. It is always a pleasure to follow the noble Lord, Lord Berkeley, and his very practical speech—I have just deleted a large section that I had about the strategic nature of support in the Government’s response because there is no point repeating it. I congratulate the noble Lord, Lord Arbuthnot, and his committee on this extremely important report, on the evidence they heard and the recommendations they have made. As the noble Lord, Lord Hunt of Wirral, said, it is an exceptional report.

For those of us who have been on councils through elective office or had Front-Bench responsibilities, or been in business, having full risk assessments and risk preparedness plans reviewed and updated on a regular basis is an absolute must, even if it is not business as usual to manage the unusual. My thanks also go to the Cygnus Reports organisation website, run by Moosa Qureshi, an NHS doctor who uncovered many other pandemic exercises in the run-up to 2020 that were not published.

The key lesson in both the report and our experiences of the Covid-19 pandemic is that cultural change to partnership working is needed across government, especially but not only with those who have a statutory responsibility to provide responses, whether or not to extreme risks. My noble friend Lord Thurso also highlighted this risk.

From these Benches, it is much regretted that there is not a clear commitment by the Government to the office for preparedness resilience or to a chief risk officer. The Government’s saying

“fold into … reform for our internal risk management structures”

can be read in a number of ways. Will the Government undertake to create both the office and the role of chief risk officer? Too many of the Government’s responses to recommendations use the words “agreeing with this principle”. I am afraid that would allow the Government to dilute these recommendations.

Pandemic planning is a perfect illustration of what went wrong in early 2020. The Government appeared to follow only Exercise Cygnus, which was for influenza. What was not mentioned is that in the preceding seven years there were seven exercises and reports, and that it took Dr Qureshi a series of legal challenges to government to be able to see and publish them. The first, in March 2015, was a report on Ebola preparedness. The second was Exercise Alice on MERS, published in February 2016. Then there was Exercise Northern Light, published in February 2016; a report on Exercise Typhon, a Public Health England command post exercise in 2017; an Exercise Broad Street high-consequence infectious disease report in 2018; Exercise Cerberus, a Public Health England national exercise, also in 2018; and a report on Exercise Pica, the NHS primary care preparedness and response to the influenza pandemic, on 5 September 2018. I read that list in full because it is clear that work was going on behind the scenes. The problem is that it was not used when we came to the pandemic.

The UK became aware at the end of 2019 of the emerging infectious disease that became known as Covid-19 from Wuhan, but it really took until March for actions to start, not least in advice to the public. As the noble Lord, Lord Arbuthnot, outlined, that was a real problem. In February, as the health Front-Bencher for the Lib Dems, I talked to the Local Government Association and to directors of public health, who were already trying to manage cases arriving back in the UK after the February half term, especially those who had been to northern Italy for skiing.

Directors of public health were asking for help and strategic support from Public Health England and NHS England, and they moved ahead fast, with local partners, to set up volunteers to help those who were at risk of isolation and the reorganisation required inside councils to ensure that priority services worked. Yet, entirely separately, the Department of Health and Social Care suddenly announced its own nationally recruited volunteer scheme—there was much confusion all round.

I talk about the need for a change of culture because this is still happening. Ministers ran campaigns this summer to encourage autumn vaccination in preparation for winter illness surges, including influenza and Covid. But it appears that, despite knowing that all the experts were warning that this would be a very tough winter—it is already tough, and we have not even got to what is usually the worst time of year—resilience arrangements were unfortunately not put in place for strep A, for example, until there was a very public shortage of antibiotics. Why were they not ordered in excess this year? Children are ending up in ICU and, sadly, losing their lives much earlier in the winter season than expected. An Ebola response report from 2015 said that a review of surge capacity would be required around paediatrics.

In addition, this week the Secretary of State talked about the high number of influenza and Covid patients in hospital. Many of those patients acquired Covid in hospital, which was probably not unassociated with the extraordinary government decision to relax the mask mandate. During the outbreaks of diphtheria—a notifiable disease under the Public Health Act—and scabies, there were notable delays to the Home Office engaging, first, with the UKHSA and with local directors of public health. I remind the House that directors of public health have a statutory duty under the Public Health Act to start working immediately on any notifiable disease. It took too long for that to happen.

The large number of reports that I outlined earlier showed that the department, Public Health England and now the UKHSA were fully aware of the risks of a rapid spread of highly infectious diseases, including Ebola, Lassa fever and influenza, but they did not follow this. Are all these previous reports being used to assess in the current review inside government—assuming there is one—how to handle the pandemic, which is not yet over, by the way? We also have 9,000 Covid cases in hospital; many of them are the very vulnerable people who were asked to shield during the pandemic. The problem with the Secretary of State for Health and Social Care saying that the pandemic is over and we have all learned to live with it is that arrangements have not been made for this group of people, who remain extremely vulnerable.

The excellent book Pale Rider: The Spanish Flu of 1918 and How it Changed the World, by Laura Spinney, notes in its final chapter that excess deaths continued for some years afterwards—some were due to flu, but they were mainly due to lung disease and heart disease. The most worrying part is that, within three years, most public bodies were back to business as before, and all of the lessons were lost.

Comprehensive risk planning and assessment, with a dedicated team that is not distracted by changes of Ministers, general elections, et cetera, are not just vital for a future pandemic: organisations that plan effectively for high risks can adapt plans for unseen and unpredicted extreme risks. When I was a group leader on Cambridgeshire County Council in the late 1990s, we had severe flooding, chemical leakages and other crises. Our bunker came into use, and the local resilience forum got under way. When foot and mouth disease hit in 2002, the LRF was able to swing swiftly into action for the county on a totally unexpected pandemic, this time with animals.

The noble Lord, Lord Rees, my noble friend Lord Thurso and others were right to say that the Treasury should provide proper resources for that, and not treat it as part of an annual budget which can be cut when times are tight. Covid has shown us over the last three years that, to save a modest amount in extreme risk planning, billions of pounds have been spent and hundreds of thousands of lives lost.

However, I want to end on a positive note, because the Government’s creation of the resilience framework is an encouraging first step. We hope that, above all, it lays the foundation for a new way forward and that the Government will also accept the two outstanding recommendations, not least because that is the only way we will get the cultural change we need.