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

Lord Allan of Hallam Excerpts

Wednesday 29th November 2023 Grand Committee

[Lord Allan of Hallam (LD)]

My Lords, I am extremely grateful to the committee for a thought-provoking report. My comments will reflect reactions to some of the recommendations within it.

I start with recommendation 1, not just logically because it is at the beginning but also because it is significant. It identifies the importance when looking at health issues of considering both the population and each individual within it. Our state of health at any moment reflects each individual’s life story. It is a combination of their genetic inheritance with socio- economic factors, their professional role—in Covid, certain jobs brought with them a different risk than other jobs—long-term health conditions, the language they speak, as the noble Baroness, Lady Coussins, pointed out, dire lifestyle factors and just a dose of good old-fashioned good or bad luck. All those factors affected each individual’s experience of Covid, and no two individuals had the same experience: both in their literal health experience, whether they were likely to suffer ill health and perhaps even death, and in their experience of lockdown and their professional and personal lives.

Covid hit people differently, and some of those differences turn out to be predictable—not the luck factors, but for some of those other factors we can say, “That tells us that your experience of a particular disease or health outcome will be different”. The report pulled that out and said that socioeconomic factors will have an impact over time, not just for Covid but for other diseases. Now that we have that awareness, it is important that we do not let it slip and just go back to thinking of the population as a whole, because those population-based statistics mask all those critical individual life experiences. We need to plan to minimise population risk and be acutely sensitive to whether we have exaggerated risks within certain segments of the population that could and should be addressed by health and other broader public policies.

The Government’s response talks about the work of the Office for Health Improvement and Disparities, and that is a useful approach. However, it is useful only if it continues this focus on the individual rather than masking those individual outcomes in the broad statistical outcomes that it is seeking. The proof of the learning will be in whether we understand future crises and respond much more quickly to those differential individual risks. I hope the Minister will be able to talk about that.

The second recommendation that jumped out at me as really insightful was recommendation 3, on local capabilities. It is important to reflect on that. I would have said that there was already enough evidence to suggest that we did not make sufficient use of local public health services; we brought everything to the centre very quickly and left people on the ground in public health services feeling that there was no role for them, and we did not take advantage of what they could offer. As we get output from the various inquiries that are going on, we will dig into that some more, particularly on the test and trace programme, which the noble Baroness, Lady Coussins, touched on. We have to be really honest about the difference when we brought something centrally and the impact that that had on demotivating local programmes.

The noble Lord, Lord Alderdice, talked about the rules and people’s immediate reaction. I thought about that as I reflected on the experience—I do not know whether anyone else had this experience—of people from centralised test and trace ringing up people in your household to tell them about your Covid, which you had already told them about because that is what people do. I learned that the best way to do test and trace was to WhatsApp all the people I knew when I had a positive test result, because that was the quickest way to get to them. Again, 10 days later somebody would phone to tell you something that you had already dealt with. The phrase “common sense” gets bandied around, but people are sensible and those very local responses were often super useful. In some ways, they were disempowered by bringing everything into the centre.

What was telling about the Scottish and Welsh experience was that people were looking to local leaders. That happened to a certain extent with some of the English regions, but it left me thinking about how much more we could have had of that if we had said that there was a role for local council leaders and others and asked them to stand up, be visible and give the advice about WhatsApping all your friends if you got a positive test result. We could have seen the impact of that, rather than getting a call from an impersonal call centre in a language that you did not even understand. As the report highlights, there was a huge opportunity to do so much more through local institutions.

We are now starting to see certain elements of the dysfunction going on in central government. Back in the day, I was a representative in Sheffield from the minority party, because most politicians in Sheffield had been Labour since time immemorial. I found in a local situation that those local loyalties far outweighed party loyalty, and we would work together very effectively. The right reverend Prelate the Bishop of London talked about faith leaders—there was a real sense that we all had to help Sheffield, whatever our religion or party. It felt to me that we could have drawn on much more of that, but people were disempowered because it was all going back to those press conferences in London and people from there telling you what you should do.

Local knowledge is also critical but was missed. If you want to know where you should put a testing centre which people will find easy to get to, you ask people in the area. There were people sitting here in Whitehall saying, “The testing centre should go there”, because it looks good on the map—but if you asked anyone locally, they would have told you that no one ever wanted to go down that street, for whatever local reason. We missed all those opportunities. I hope the Minister can at least give us some indication that any future planning will be much more sensitive to and take advantage of the fact that we have amazing local structures that can be utilised in such a crisis.

On recommendations 7 and 9 on long-term planning and efficiency, what happened around procurement is a stark example of why that is needed. We saw the best and worst in the pandemic: we saw people pitching in for the public interest, but we also saw blatant profiteering. As the noble Lord, Lord Alderdice, pointed out, part of it is the redundancy question. If you have taken everything down to the bone, you have made yourself more vulnerable to those who will come along and sell you something, because you have to buy it at any price. There was no cushion there, and cushions matter if you want to insulate yourself against that kind of situation.

This is also about planning and advance frameworks for procurement and staffing. Whether it is procuring equipment or staffing, this is squarely in the domain of the Cabinet Office and it could be thinking now about how we avoid that, whether it is a health emergency or any other situation where we have an urgent need to procure people and stuff in the public interest. How do we make sure that we do not expose ourselves to that profiteering? I think that I am safe in this environment to use this reference, but there will always be Private Walkers—that famous figure, the spiv from “Dad’s Army”, for those who are not of that generation. There will always be somebody. Since time immemorial, there have always been people who will take advantage, but we can do things to protect ourselves against that. Part of that might be the Cabinet Office thinking about what kind of profit limits would be appropriate. People can make profit, that is fine—we want them to be creative and think of new solutions—but there should be limits to that, which is something that could be thought about ahead of time.

Transparency rules would be helpful. We are told that a lot of those contracts were commercial, so it is now really difficult to unpick that and to understand whether people were profiteering or just charging a fair mark-up, which would have been fine. If they delivered the goods and charged a fair mark-up, we are okay, but if they were putting on an excess mark-up because they knew that they could take advantage, they were being Private Walkers. We need to know that and be able to dig into it. That area is really significant, and I hope that the Minister will be able to say that this is a priority for the Cabinet Office.

The last set of recommendations that jumped out at me are 16 and 17, on online activity generally, and 21 and 22, on digital health in particular. We had a huge, forced learning process. My noble friend Lord Alderdice talked about our late Queen, who also had to learn; she was forced into the situation of learning how to do digital signing. During that crisis, all of us were forced to do things digitally. The technology held up remarkably well, in fact. I was quite surprised—I think the noble Baroness, Lady Lane-Fox, who has a lot of experience, may have shared my surprise. I thought that we would break the internet with that massive usage, but we did not. However, because the technology held up quite well, in some ways it masked a whole bunch of social questions that we were not asking. The real questions were not necessarily the technological ones, other than for those who did not have access at all. For most people who had access, there were a range of social questions that, in some ways, were much more significant than the technology.

Any parent whose children went through Covid—mine did—will certainly recognise that the impact was significant, even where the technology worked perfectly and even where the schools were good. It was not zero impact. Mine still talk about it; they were not in exam years but it is still relevant to their experience of education today and how they feel about education.

There is also a risk that the debate becomes binary; it is either all offline or all online—whether that is health, education or work. My noble friend Lord Alderdice and the noble Lord, Lord Patel, referred to GP consultations, and there is almost this sense that we need to move everything online or we need to get everything offline, when the world is much more complicated than that. The reality is that it is about individuals who have individual needs and individual preferences. There will be some children who struggle in school social settings—and always have done. A lot of them were absent from school, and online is a wonderful bonus. I can remember going back and dealing with children who were persistently truant from school, and were truant because they genuinely struggled. Online may be a better solution for those individuals. There are other children who really struggle by not being in school, for whom online is a terrible experience. We need, again, to recognise that. It is hard for those who are delivering education—it is much harder than a single model—but, if we want to respond to people’s needs, we need to think about how we are going to do that.

In the healthcare sector, there are many people who will benefit from virtual wards—another development that has come out of all this—and who would rather be at home than in a hospital setting. There will be others, however, for whom being in hospital is essential—often for socioeconomic factors—and at home they just would not get the care that they need. It is not one size fits all. It is not all virtual or all in hospital; it is about reflecting the individual circumstances. The Government’s response to the report talks about the need for new medical systems to be approved by the MHRA. That is right but, again, the risk is that we focus on the technology. Approving the technology as suitable for home use is one thing, but approving the protocols that decide when you use the technology versus when you use in-person is a whole other set of questions that we need to address.

I am grateful to the committee for a very comprehensive report with so much thought-provoking content. I have touched on a few points but I read the other reports with great interest and will learn a lot from them. If we can learn these lessons, we can be better equipped for future crises of all kinds that we are going to face. It will be deeply disappointing if we hit another crisis and do not do better. There is no excuse for not doing better if we take on board these lessons. I am grateful to the committee for giving us the opportunity to focus on the kind of things that we could do to achieve that better outcome.