COVID-19 policy in the UK: oral evidence to the Health and Social Care Committee (5th March- 3rd June 2020)

This series of posts describes the key themes and issues to arise from oral evidence to the House of Commons Health and Social Care Committee on COVID-19. It is the first committee on my to-do list.

When possible, I have (or will) connect them to some other sources of information, such as the minutes from NERVTAG, the not-yet-read-by-me minutes by SAGE, and the 8000-word paper that I am writing (which is currently 20000 words, and based initially on this unwieldy blog post). The result is a very long read, which I have broken down into a collection of 9 reads. One unintended consequence is that you may not see a respondent’s full title in some posts, because originally I only listed it the first time on the full document. Fortunately, there is a simple solution: read all the posts from 1-8.

Two issues often seem to dominate the oral evidence to the Health and Social Care Committee in multiple sessions from March to June 2020:

1. Limited testing: antigen testing to detect the virus now, then antibody testing to detect if someone had COVID-19 in the past.
2. Shortages of personal protective equipment (PPE), initially for NHS staff, followed by concerns about availability in social care and other sectors.

These issues connect to a series of knock-on issues, such as the discharge of patients from NHS hospitals to care homes without being tested.

They also intersect with broader policy themes which include how to:

3. Define coronavirus as a policy problem, such as with reference to the oft-abused phrase ‘herd immunity.
4. Act despite uncertainty, or a lack of information on which to give advice and make choices.
5. Define different stages of intervention, including contain, delay, research, mitigate, and suppress.
6. Describe the relationship between science advice and policy, to project the sense that policy is evidence-informed but that elected politicians are responsible for choice.
7. Identify the many changes to policy and practice that would otherwise receive minimal attention (in other words, they are low salience but high importance).
8. Address the links between health inequalities and race and ethnicity.

These sessions generally relate to activity for England, but with few indications that the actions or issues are markedly different in Northern Ireland, Scotland, or Wales. Indeed, (a) there is frequent reference to UK-wide cooperation and coordination, and (b) issues such as NHS hospital discharges to care homes without testing or quarantine measures seem UK-wide (albeit with variations in practice). A proper focus on devolved government is also on the to-do list.

PS I also left out some issues because they seemed unresolved by June:

• Test, track, and trace (Hancock, 17.4.20: q325-7; Vallance and Harries, 5.5.20: q425-8; Chen, 3.6.20: 492-504; Fraser, Professor of Pathogen Dynamics, University of Oxford and Harding, Executive Chair of NHS Test and Trace programme, 3.6.20: 510-52)
• When to have border restrictions (Cooper, 17.4.20: q344)
• Testing for a vaccine (Van-Tam, Deputy Chief Medical Officer, 17.4.20: q366)
• Who to learn from, in relation to comparability (Vallance, 5.5.20: q435; see also the dedicated session 19.5.20 on South Korea, Hong Kong, Germany).

The full series of posts:

1. The need to ramp up testing (for many purposes)
2. The inadequate supply of personal protective equipment (PPE)
3. Defining the policy problem: ‘herd immunity’, long term management, and the containability of COVID-19
4. Uncertainty and hesitancy during initial UK coronavirus responses
5. Confusion about the language of intervention and stages of intervention
6. The relationship between science, science advice, and policy
7. Lower profile changes to policy and practice
8. Race, ethnicity, and the social determinants of health