UK Covid-19 Inquiry report: Resilience and preparedness

Approximate read time: 15 minutes

1. What is the UK Covid-19 Inquiry?

The UK Covid-19 Inquiry is an open independent public inquiry set up to examine the UK’s response to and the impact of the Covid-19 pandemic, and learn lessons for the future.^[1] The inquiry was established by the previous Conservative government during Boris Johnson’s premiership. The inquiry was set up in June 2022 and formally opened by the chair of the inquiry in July 2022. The chair is former Court of Appeal judge Baroness Heather Hallett.

The UK Covid-19 Inquiry was established on a statutory basis with full powers under the Inquiries Act 2005.^[2] This means the chair has the power to compel the production of documents and to call witnesses to give evidence on oath. The inquiry’s work is guided by its terms of reference.^[3] They set out that the inquiry will consider and report on preparations and the response to the pandemic in England, Wales, Scotland and Northern Ireland, up to and including the inquiry’s formal setting-up date, 28 June 2022.

When Baroness Hallett launched the inquiry in July 2022, she outlined her decision to divide the inquiry’s investigation into modules. Each module has a corresponding preliminary hearing and a full hearing. As at the start of August 2024, nine modules had been announced:^[4]

• Completed modules: resilience and preparedness (module 1)
• Active modules: core UK decision-making and political governance including in Scotland, Wales and Northern Ireland (module 2); impact of Covid-19 pandemic on healthcare systems in the four nations of the UK (module 3); vaccines and therapeutics (module 4); procurement (module 5); care sector (module 6); and test, trace and isolate (module 7)
• Announced modules: children and young people (module 8); and economic response (module 9)

Further modules may still be added.

2. What was the focus of the UK Covid-19 Inquiry’s first report?

The UK Covid-19 Inquiry published its first report on 18 July 2024, setting out its findings and recommendations following the conclusion of its investigation into the UK’s ‘Resilience and preparedness (module 1)’.

Module 1 examined the state of the UK’s central structures and procedures for pandemic emergency preparedness, resilience and response.^[5] It considered whether the pandemic was properly planned for and whether the UK was ready for that eventuality. The module looked at the whole system of civil emergencies including resourcing risk management and pandemic readiness. It scrutinised government decision-making relating to planning.

The first public hearing of the inquiry, on module 1 (resilience and preparedness), took place in London in June and July 2023.^[6] Prior to the hearing, a process of obtaining potentially relevant documents from a wide range of sources took place and more than 18,000 documents were deemed relevant. The module 1 inquiry team obtained more than 200 witness statements and called 68 factual and expert witnesses, including people from the UK and devolved governments, scientists, civil servants, people from resilience and health structures and bereaved family members.

3. What were the UK Covid-19 Inquiry’s findings?

In her statement following the publication of the report, Baroness Hallett said that the UK had “prepared for the wrong pandemic”.^[7] She said that the UK was “ill-prepared” and “lacked resilience” going into the pandemic. Baroness Hallett said citizens of all four nations were failed.

In the report, the inquiry acknowledged that “politicians have to make tough decisions about how to use resources to prepare for emergencies”.^[8] However, the inquiry found the system of building preparedness for the pandemic suffered from several significant flaws:

• The UK prepared for the “wrong pandemic”.^[9] The significant risk of an influenza pandemic had “long been considered, written about and planned for”. However, that preparedness was “inadequate for a global pandemic of the kind that struck”.
• Emergency planning was complicated by the many institutions and structures involved. The responsibility within the UK government and devolved governments and their supporting organisations were “duplicative, diffuse and delegated too far from ministers and senior officials to allow them to be effectively overseen”.^[10] The report described the system as “unduly complex and labyrinthine”. It found that the complexity of the system caused various problems including an inefficient system, a system prone to working in silos, and a lack of focus because of an absence of clear leadership and oversight by both ministers and officials.^[11]
• The approach to risk assessment was flawed. There were “five major flaws” in the approach to risk assessment in the UK that had a “material impact on preparedness for and resilience to whole-system civil emergencies such as pandemics”. These flaws were: too much reliance was placed on a flu pandemic scenario; planning focused on dealing with the impact of disease rather than prevention; it did not adequately account for interconnected risks and a ‘domino effect’; a failure to appreciate long term risks and their effect on vulnerable people, this included a failure to appreciate the range of people who may be vulnerable to a pandemic; and insufficient connection between the assessment of risk and the strategy and plan for dealing with it.^[12] The report also found that risk assessments by the devolved governments “simply copied” that of the UK government, which limited their “utility as a risk assessment tool” because they did not assess how particular risks would affect the populations of individual nations.^[13]
• The UK government’s “outdated” 2011 ‘UK influenza pandemic preparedness strategy’ was not flexible enough to adapt to the Covid-19 pandemic.^[14] The inquiry report commended the strategy for correctly identifying that the impact a pandemic would have on the population and wider society would be determined by three factors: the characteristics of the disease; the capacity of healthcare services, other public services, utilities and businesses; and the behavioural response of the population to public health advice, antiviral medicines, vaccination and the use of healthcare services.^[15] However, the inquiry found the strategy had four major flaws: failure to adequately consider prevention; focus on only one type of pandemic; failure to adequately consider proportionality of response; and lack of an effective economic and social strategy. The inquiry report highlighted the strategy had not been reviewed since it was updated.
• Emergency planning failed to put enough consideration into existing health and social inequalities and local authorities and volunteers were not “adequately engaged”.^[16] It said these “failures left the most vulnerable people in society exposed to the effects of a pandemic.^[17]
• There was a failure to fully learn from past civil emergency exercises and outbreaks of disease, such as swine flu, the Ebola virus or SARS outbreaks. The inquiry noted various instances where there had been a failure to implement or complete recommendations from simulation exercises, such as ‘Exercise Cygnus’ in 2016. A key learning outcome from that exercise had been that the UK preparedness and response, in terms of its plans, policies and capability, was “currently not sufficient to cope with the extreme demands of a severe pandemic that will have a nation-wide impact across all sectors”.^[18] The report also noted that a fundamental flaw in the exercise was that it did not consider anything wider than a flu pandemic.
• There was a lack of attention to the systems that would help test, trace, and isolate.^[19] Policy documents were outdated, involved complicated rules and procedures which could cause long delays, and they were full of jargon and were overly complex.
• Ministers, who were often without specialised training in civil contingencies, did not receive a broad enough range of scientific advice and often failed to challenge the advice they did get.
• Advisers lacked freedom and autonomy to express differing opinions, which led to a lack of diverse perspectives. Their advice was often undermined by “groupthink”: a “phenomenon by which people in a group tend to think about the same things in the same way”.^[20] The report found that scientific advisors generally responded to specific requests for advice. It said that there should be a “balance between advice commissioned from the top downwards and advice being given, spontaneously, from the bottom upwards”.^[21]
• There were major omissions from the expert committees advising governments on pandemic preparedness.^[22] The advice was biased towards biomedical advice and did not include socio-economic advice from comparable experts.

On the issue of the preparedness of the healthcare system and the impact of “historical or potential future funding cuts”, the report explained that the capacity and resilience of the health and social care systems would be considered by the inquiry in subsequent modules.^[23] However, the report did state:

[…] it remains the case that the surge capacity of the four nations’ public health and healthcare systems to respond to a pandemic was constrained by their funding.^[24]

The inquiry concluded that:

Had the UK been better prepared for and more resilient to the pandemic, some of that financial and human cost may have been avoided. Many of the very difficult decisions policy-makers had to take would have been made in a very different context.

Preparedness for and resilience to a whole-system civil emergency must be treated in much the same way as we treat a threat from a hostile state.^[25]

4. What were the UK Covid-19 Inquiry’s recommendations?

The UK Covid-19 Inquiry’s first report made 10 key recommendations and set out timescales in which they should be implemented. At the launch of the inquiry’s report, Baroness Hallett argued that if the report’s 10 recommendations were implemented, the UK would be more resilient and better able to cope with a pandemic. She stated:

Today the inquiry has published its first report after examining the resilience and preparedness of the United Kingdom to respond to a pandemic. My report recommends fundamental reform of the way in which the UK government and the devolved administrations prepare for whole-system civil emergencies.

If the reforms I recommend are implemented, the nation will be more resilient and better able to avoid the terrible losses and costs to society that the Covid-19 pandemic brought.^[26]

The report on module 1 recommended a “major overhaul” of how the UK and devolved governments “prepare for whole-system civil emergencies”.^[27]

In summary, the report’s 10 key recommendations were:

• A “radical simplification” of the civil emergency preparedness and resilience systems.^[28] This includes rationalising and streamlining the current bureaucracy and providing better and simpler ministerial and official structures and leadership. The governments of the UK, Scotland, Wales and Northern Ireland should each simplify and reduce the number of structures with responsibility for preparing for and building resilience to whole-system civil emergencies.^[29]
• Cabinet office leadership for whole-system civil emergencies in the UK. The UK government should abolish the lead government department model for whole-system civil emergency preparedness and resilience and require the cabinet office to lead on preparing for and building resilience to whole-system civil emergencies across UK government departments.^[30]
• A new approach to risk assessment that provides for a better and more comprehensive evaluation of a wider range of actual risks.^[31]
• A new UK-wide approach to the development of strategy, which learns lessons from the past and from regular civil emergency exercises, and takes proper account of existing inequalities and vulnerabilities.^[32]
• Better systems of data collection and sharing in advance of future pandemics, and the commissioning of a wider range of research projects.^[33]
• Holding a UK-wide pandemic response exercise at least every three years.^[34] The exercise should: test the UK-wide, cross-government, national and local response to a pandemic at all stages, from the initial outbreak to multiple waves over a number of years; include a broad range of those involved in pandemic preparedness and response; and consider how a broad range of vulnerable people would be helped in the event of a pandemic.
• Publishing the findings and lessons from civil emergency exercises.^[35] This should include an action plan setting out the specific steps that would be taken in response to the report’s findings, and by which entity, within six months of the conclusion of the exercise. The report recommended keeping the exercise reports, action plans, and emergency plans and guidance from across the UK in a single, UK-wide online archive, accessible to all involved in emergency preparedness, resilience and response.
• Publication of regular reports on whole-system civil emergency preparedness and resilience.^[36] The governments of the UK, Scotland, Wales and Northern Ireland should each produce and publish reports to their respective legislatures at least every three years on whole-system civil emergency preparedness and resilience.
• Regular use of red teams.^[37] The UK and devolved governments should introduce the use of red teams in the civil service, bringing in external expertise from outside government and the civil service to “challenge and guard against the known problem of groupthink”.^[38]
• “Most importantly, the creation of a single, independent statutory body responsible for whole system preparedness and response”.^[39] It would consult widely, for example with experts in the field of preparedness and resilience, and the voluntary, community and social sector, and provide strategic advice to government and make recommendations.

Baroness Hallett has said that she expects all the report’s recommendations to be implemented within the timeframes set out.^[40] The report explains that the recommendations “are designed to be implemented and work together; to produce real change in how the UK prepares for emergencies like pandemics”. The inquiry intends to monitor the implementation of the recommendations and to “hold those in power to account”.^[41]

5. What was the reaction to the UK Covid-19 Inquiry’s first report?

Prime Minister Keir Starmer said the report confirmed that the UK had been underprepared for the pandemic, and that that “process, planning and policy across all four nations failed UK citizens”.^[42] In a written statement to the House of Commons, Mr Starmer said:

I am personally committed to each and every family who lost loved ones, and whose lives were changed forever, that this government will learn the lessons from the inquiry. This means ensuring that the UK is prepared for a future pandemic, as well as the broadest range of potential risks facing our country. That is a top priority for this government and what everyone should rightly expect from a government working in their service.

The government are committed to working with our colleagues in the devolved governments, mayors and local partners as we carefully consider the recommendations in the report, as their efforts are vital to ensuring the resilience of the whole of the United Kingdom.^[43]

Scotland’s first minister, John Swinney, welcomed the report and said the Scottish government would “carefully assess” Baroness Hallett’s recommendations and give responses “within the timescales that have been set out”.^[44]The Welsh government made a similar statement, saying that it looked forward to “working together in equal partnership with the UK and other devolved governments in responding to them”.^[45] The administration in Northern Ireland said it was establishing a cross-departmental steering group to consider and progress implementation of the recommendations.^[46]

Jeremy Hunt, who was health secretary between 2012 and 2018,^[47] said the report had many “sensible” recommendations, including “simplifying the structures for preparing for these kind of emergencies”.^[48] He acknowledged that, as health secretary, he had been part of a “groupthink” that “over-prepared” for a flu pandemic, but “didn’t think of other types of pandemic”. He said that “we should have challenged that groupthink”. Mr Hunt, now shadow chancellor of the exchequer, said:

I apologise unreservedly to the families—that was the most terrible tragedy, what happened to this country during Covid.^[49]

While the Covid-19 Bereaved Families for Justice welcomed the report’s recommendations, the group felt the inquiry had not gone far enough on dealing with inequality. On the day the report was published, a spokesperson for the group said it was “relieved” to see many of its recommendations reflected in the report.^[50] However, they said the recommendations had “not gone far enough in setting out how we can challenge, address and improve inequalities and capacity of public services as opposed to just understanding the effects of these failures”. It called on the government to produce a plan to address health inequalities and to conduct a cross-departmental audit into pandemic preparedness.

The Health Foundation’s response to the report also focused on the need to address inequalities and particularly health inequalities.^[51] Chief Executive Dame Jennifer Dixon said the inquiry had “brought into sharp focus the deep health inequalities” that existed, which had left communities with poorer health “significantly more vulnerable to the virus”. She argued:

Radical reform of how we plan and prepare for future emergencies needs to go hand in hand with action to improve the nation’s health, a renewed effort to tackle inequalities and support for a stronger and more resilient health and care system.^[52]

Dame Jennifer also stressed that the “failure of strategic planning for a major health emergency was compounded by the lack of resilience within public services”.

The Local Government Association was pleased to see the report “recognis[ed] the important role local government and directors of public health have in the response to any pandemic” as “part of a whole system civil emergency response going forward”.^[53] It called for local government to be at “the heart” of developing the response to the inquiry’s recommendations.

6. Read more

• House of Commons Library, ‘Covid-19: The public inquiries’, 23 March 2022
• House of Lords Library, ‘Life beyond Covid-19: Lords Covid-19 Committee’s recommendations for long-term resilience and wellbeing’, 23 November 2023
• House of Commons Library, ‘Statutory public inquiries: The Inquiries Act 2005’, 25 July 2024

---

Cover image by Mateus Andre on Freepik.