Failure of the Elite (5): Advising the Government – struggle to be heard and remain independent
- lisaluger
- Jan 27, 2022
- 16 min read
Updated: Jun 9, 2023
Chris Ham, the former CEO of the King’s Fund, analysed in the British Medical Journal (BMJ) the reasons for the UK’s poor record in tackling the pandemic. Among the Government’s numerous other weaknesses, he exposes its inability to incorporate knowledge about the virus into decisions for or against any measures. Chris Ham sees this as the leading cause of the massive mistakes the UK has experienced in these crisis years.
Boris Johnsons’ autocratic governing style was responsible for the fact that the expertise of a vast spectrum of experts went unheard. The experiences of other countries, especially those of European states, had also received little attention because the Prime Minister and his cabinet were convinced of their superiority. Thus, opportunities that could have saved lives and livelihoods were lost.
Source: BMJ 2021 The UK’s poor record on covid-19 is a failure of policy learning. The King’s Fund. BMJ 2021:372.n284. 10 February 2021.
This elitist arrogance and know-it-all attitude of individual politicians prevent genuine expert and experiential knowledge from being incorporated into planning and strategy development and implementation. The consequences are devastating.
Do they know that they know nothing?
Politicians, like all leaders, are not expected to be a walking encyclopaedia with a wide range of expertise, as they were in the Middle Ages and the early Modern Era. The mark of quality in the 21st century is knowing which gaps in knowledge need to be filled by experts to solve a task or problem. Moreover, the complexity of our globalised world and our interconnected society means that almost every action generates many interlinked reactions. To reasonably assess these consequences, you don’t need a flock of head-nodding staff and consultants who don’t dare to disagree or are unwilling to question strategies. What is required is a team of diverse theoretical and practical competencies that can look at a problem from different angles and work together as equals.
However, this insight of being just as dependent on practitioners as on academics was mostly absent among government representatives. Instead, they were convinced that the SAGE advisory group, consisting mainly of medically trained academics, could best advise the Government on the pandemic. Unfortunately, initially, the pandemic was interpreted solely as a medical problem. Therefore, its far-reaching impact on all sectors of society was not understood. Practitioners such as social scientists, public health workers, social workers and caregivers, professionals experienced in dealing with pandemics, and education and business experts were left out. As a result, whole sectors and essential areas of society were not consulted.
Together we are wiser
The consequences of government measures that have not been sufficiently thought through because various affected social groups were not included in the strategic planning can be seen by the effects of the school closures.
Schools were closed and reopened without the consultation of headmasters, teachers and parents. Also, without warning. Had the responsible experts been consulted, some hardships could have been avoided. For example, online supervision of students during the lockdown would have been better planned, and thought would have been given to providing disadvantaged students with resources such as laptops. Teachers and parents would certainly not have forgotten that the lockdown would mean that school meals would be discontinued, and underprivileged children who depend on the free daily school meals would have to be fed in other ways. Unfortunately, government members did not climb down into these lowlands of everyday problems. It took footballer Marcus Rashford to campaign for the free school meals system to continue during the lockdown.
Schools were due to reopen after the 2020/21 Christmas holidays. So parents, teachers and children were preparing for the start of school. But after two days of opening, the then Education Minister, Gavin Williamson, decided it would be better to close the schools again. Many problems could have been avoided had he worked with teachers, headmasters, and parents before deciding. For example, schools were left sitting on tons of food for school lunches and parents, whether at home offices or their workplaces, did not know how to supervise their children who were sent back home.
When hospitals ran out of beds due to the volume of covid patients, the Minister of Health decided that elderly sick people should be discharged early to their nursing homes to free up beds. Social workers and geriatric nurses would have warned against this measure. They would have pointed out the risk that the virus could be brought into the nursing home along with the discharged residents. They would certainly have insisted on testing the patients for Covid before their release. This oversight has led to vast Covid infections and over 20,000 deaths in nursing homes.
Better communication and collaboration between ministers and school and care home leaders, GPs, hospitals and public health teams would have been crucial to learning from the experience on the ground and developing a robust, well-thought-out pandemic response strategy with appropriate and workable measures.
However, during the first lockdown, Boris Johnson and his ministers were also reluctant to draw on the expertise and knowledge of the devolved administrations, regional and local government leaders and experts on public health issues, etc. The mayors of the most populated cities, such as London, Birmingham, Manchester and Liverpool, had not been consulted before far-reaching lockdown measures had been put in place. These local politicians only found out via Twitter or newspaper what measures the Government had decided. However, they were expected to implement them.
Was this a party political decision (because the mayors of most big cities are Labour members) or an oversight? In any case, this approach has a stale taste.
If, however, there was no intention behind it but carelessness, then this would indicate maximum incompetence on the part of the Government.
Mayors are responsible for the well-being of millions of people in their city and many large and small businesses, shops, workplaces, pubs, restaurants, hairdressers etc. In addition, they are responsible for public services such as police and transport etc. Yet, they were left out of the loop when the national Government decided on a regional or national lockdown. Didn’t the decision-makers realise that life goes on despite the lockdown? Not all workers could retreat to the home office. Many still had to make their way to work, travelling on buses and subways that had to be made as Covid safe as possible. People needed food and services. This had to be provided, and sufficient resources had to be made available. For example, the Mayor of Manchester, Andy Burnham, complained about insufficient financial help for business people in Manchester. The £60 million promised by the Government would only cover 66% of the costs, Mayor Burnham said.
In business, this would be called a management error. A more inclusive management style with close cooperation between regional and local leaders and the devolved administration would undoubtedly have been more effective.
Decision-making in a crisis
The Covid pandemic requires difficult decisions in challenging circumstances and makes it hard to craft sound policy. However, the UK government has an unfortunate habit of delaying decisions and making unclear or short-sighted decisions that then have to be quickly withdrawn when it turns out that their implementation is not possible. It is, therefore, essential to have a clear goal and a clear planning concept on how this goal is to be implemented.
In April 2020, the Institute for Government examined government decision-making on some decisions in the early stages of the pandemic. The report shows that decisions work best when the Government knows what it wants to do and how best to implement what it wants to do.
Source: Institute for Government (April 2020) Decision making in a crisis. Report. April 2020.
– Test-and-trace programme – a disaster
This was not the case, for example, with what was supposed to be the world’s most successful test-and-trace programme. Matt Hancock, the then Minister of Health, obviously under pressure to succeed, set a target for the programme to reach 100,000 tests per day. Unfortunately, there was no strategy to achieve this arbitrary figure. It was unclear where to set priorities and who should be tested first. Should the professional groups and people who are particularly exposed to the virus go first? Or those particularly vulnerable due to pre-existing conditions and their age?
There was no plan to meet the suddenly high demand for additional laboratory capacity to process the tests. There was also no plan for how to organise cooperation with external testing laboratories to create the necessary capacity. There was also no consideration of how to ensure access to a local testing centre for people willing to test. How can people be forced to travel 250 km by car to the nearest test centre? People without the luxury of a car had to use public transport, regardless of the risk of infecting other passengers with Covid. These problems were caused because the Minister of Health took decisions without consulting the diagnostics industry, the NHS, or other relevant experts. Without planning and implementation strategy, the test project was doomed to fail.
– Economic support package – a prime example of collaboration
However, when it came to putting together a package of measures to support the economy to avoid a flood of unemployed people and company bankruptcies, the government officials in charge worked quickly and effectively. The Job Retention Scheme or Furlough, the Self-Employment Income Support and the Corona Business Interruption Loan Scheme were developed in a short time and put into practice swiftly with few problems. The success was because government ministers and officials consulted those affected through their advocacy groups. In addition, they worked closely with businesses and trade unions and planned jointly for implementation before making a decision.
The approach was pragmatic. The priority was to provide quick and non-bureaucratic financial assistance to millions of workers and employers. Individual tailoring of the financial aid to different needs was not crucial in this approach.
Close cooperation with companies, associations and trade unions significantly boosted acceptance among those affected.
Another decisive factor for the programme’s success was that the programme’s implementation had been considered from the beginning. The cooperation between the treasury ministers and officials with the HMRC, which was ultimately responsible for implementing the most critical measures, was effective, efficient and, therefore, successful. As a result, the feared a blatant increase in the unemployment rate was avoided.
What can we learn from this?
As the Institute for Government’s research has clearly shown, decision-making in a crisis does not necessarily have to result in a series of wrong decisions. On the contrary, with the right input and the consultation and participation of relevant stakeholders, a government can be perfectly capable of reacting quickly and effectively.
But this would require ministers to communicate more clearly the objective of their actions. A broad range of experts needed to be consulted in advance to carry out a comprehensive analysis of the situation and develop adequate solutions. The expertise and advice of different actors are essential for decision-making in complex situations and for creating a viable strategy from different perspectives. But again, as mentioned earlier, know-it-all and teamwork do not go together.
Vaccination campaign – a successful project
Another positive example is the vaccination campaign that the United Kingdom carried out on its own.
UK immunisation data as of 7 January 2022:
A total of 134.8 million vaccinations have been carried out, of which received:
First vaccination: 51.9 million, received, a second vaccination 47.6 million, booster vaccination 35.3 million Source: https://coronavirus.data.gov.uk/details/vaccinations
Why was this vaccination campaign so successful?
The responsible decision-makers of the newly established vaccination task force seem to have learned from past mistakes. They relied not only on their connections but predominantly on the know-how of experts from the field.
Boris Johnson appointed Kate Bingham to develop and procure Covid vaccines in May 2020. Then, in the of summer 2020, he entrusted Sir Simon Stevens, the head of the NHS, to plan, manage and deliver the national vaccination campaign, which included vaccinations for the entire UK population. The challenge was to avoid the problems posed by the Test and Trace programme, which was carried out mainly by external contractors and largely ignored local and practice expertise.
Kate Bingham worked closely with scientists in research institutions and the pharmaceutical industry who had already been working on vaccine development since the beginning of the pandemic. She supported them with the financial resources they needed. Kate Bingham took a considerable risk by ordering 500 million vaccines from several manufacturers even before the vaccines were officially licensed. However, taking this risk paid off, as the UK was the first country in the world to receive, approve and use Oxford/AstraZeneca and Pfizer/BioNTech vaccines.
Sir Stevens relied on NHS experts and networks. He involved associations of GPs, i.e. primary care networks, each caring for an average of 50,000 patients. They had to agree to be available 12 hours a day for vaccinations. In addition, 30,000 NHS staff and 100,000 volunteers signed up to help organise the 1,500 vaccination centres in football stadiums, gyms and other large buildings. well-accessible
Fifty military logistics experts were called in to perform logistical tasks at NHS headquarters. This included establishing vaccination centres in well-accessible locations to allow broad access, organising the distribution of vaccines and securing the delivery of vaccines and the vaccination process.
The vaccination was distributed according to the principle of ensuring equal access. Call for vaccination and documentation of vaccination completion was done using the NHS database. Priority was given to the elderly and at-risk groups and medical staff and social workers, followed by age prioritisation. The process of the first vaccination was accelerated by extending the time until the second vaccination. In this way, the existing capacity was optimally used for the first immunisation.
Sources:
UK vaccine rollout success built on NHS determination and military precision. 12 February 2021. https://www.ft.com/content/cd66ae57-657e-4579-be19-85efcfa5d09b .
How the UK vaccine rollout delivered success so far. https://www.bmj.com/content/372/bmj.n421. Covid-19:
As with any mass campaign, there were undoubtedly glitches and a few unhappy people, but on the whole, the campaign was a success.
Unfortunately, only two projects can be described as goal-oriented and thriving in these crisis years. So, even this Government, which is resistant to consultation, must realise that, in the end, it knows nothing and must therefore call on the expertise and experience of the most diverse sections of society. – Provided it really wants to govern for the good of the country and its citizens.
Government’s relationship with science
It seems that the British Government has developed a somewhat ambivalent relationship with science and scientists during the Covid crisis. The expert findings usually serve as a justification, sometimes as an excuse, and throughout, they are readily interpreted as a suggestion for political action. But on the other hand, the government members are also prepared to exert pressure if the scientific results do not comply with their aspirations.
-Science as justification only works to a limited extent
Every time the Government was criticised for failing to deal with the covid crisis, it pointed to the scientists. During interviews, the respective government representative said that scientific findings guided them and that they see no reason for an apology. So they conveniently pass the buck to the scientific advisors. However, this has nothing to do with responsible action.
A government clearly must consult scientific advisors and take their findings into account in the decision-making process. However, not the scientists are the people’s elected representatives but the MPs and the Government. The responsibility lies with them. They have the task of drawing on the wealth of knowledge of science, taking into account different societal interests, to generate conclusions that result in laws and measures. Scientists inform policy-makers but do not make policy. Ministers bear political responsibility and must be aware of the limitations of science. For example, the scientific advisors to the SAGE Committee were reluctant when the Government representatives expected them to recommend wide-ranging restrictions at the beginning of the pandemic. As experts in medicine, they did not feel competent to make recommendations that had far-reaching economic and social implications.
Apart from the fact that science needs competent, open and responsible politicians to serve society, the British politicians’ alleged faith in science is situational.
-Advice from science? – No thanks!
The Government’s favourite justification, “We have been guided by science”, is no longer even remotely applicable in December 2021. The scientists’ advice goes unheard because it does not fit into the Government’s concept of doing nothing.
In the last months of 2021, scientists vociferously expressed their concerns about the increasing Covid infections in the country and called on the Government to implement its Plan B. This plan envisages a series of more stringent measures, such as wearing masks in public places, social distancing, and working in home offices where possible. But government ministers stoically stuck to their decision to rely on vaccination and booster shots alone.
More recently, top scientist and director of the Wellcome Trust, Sir Jeremy Farrar, warned that the UK’s progress in combating Covid was now being undone and lamented a lack of political leadership in the pandemic. Farrar had resigned as a Government’s scientific adviser in November 2021 to focus more on international research to combat the virus. He said measures such as wearing masks indoors, increased testing, social distancing, isolation if positive with appropriate financial support and vaccination were urgently needed to contain the virus. Sir Jeremy Farrar calls this strategy “vaccination plus”. However, the Government stubbornly refused to implement Plan B, insisting that vaccination, or boosters, is the solution!
Scientific advice is clearly ignored if it does not fit the Government’s mindset.
-Science under pressure – independence is sometimes a farce
The population wants to trust government decisions, and they want to believe in the findings of science, especially in times of crisis. Second, the people want to be sure that scientific statements are made without political pressure. Third, the public wants to rule out the possibility that conflicts of interest have influenced reports and measures. Finally, the public wants scientists to research and publish independently and neutrally, especially when a crisis needs to be tackled with the help of science. Transparency is necessary to meet this need.
However, governments can control science and suppress its results. They can do so by arguing that this is in the public interest, e.g., speed up the availability of diagnosis and treatment, promote innovation, or save lives. This is precisely what has happened in the UK.
Kamran Abbasi, editor-in-chief of the British Medical Journal, argued that science in the UK is suppressed for political and financial reasons. He cited several examples of how the Government pressured science during the pandemic in the UK and how inconvenient truths were ignored and concealed.
Source: Covid-19: Politicisation, “corruption”, and suppression of science. When good science is suppressed by the medical-political complex, people die. BMJ 2020;371:m4425. 13 Nov 2020.
For example, government advisors were inappropriately involved in the SAGE committee. SAGE is a politically and economically independent committee of scientists who provide their expertise to the Government and advise it on managing the Corona pandemic. The regular presence and participation of government officials and Boris Johnson’s political advisors, such as Ben Warner and Dominic Cummings, could compromise the committee’s independence. On the other hand, it could also facilitate communication between the committee and the Government, enhancing collaboration. The fact that the list of participants in the deliberations was secret until it was leaked and published in a daily newspaper, however, supports accusations of lack of transparency and fuels suspicions of undue influence by the Government.
At the beginning of the pandemic, the scientists were praised by politicians, the media and large parts of the population. The mood has now changed. Used by politicians as scapegoats when something had gone wrong (“We followed the advice of scientists”), headlines in some pro-government British newspapers blame government scientific advisors and members of scientific committees for the collapse of the economy, the rise in unemployment and the destruction of livelihoods.
The Government does not defend them. They are no longer considered impartial and independent scholars. They are accused of leaking documents to journalists, representing their own personal views and collaborating with opposition political parties.
Behind these accusations is the Government’s assumption that a scientist who is a member of an expert group advising government members has decided to be part of the government team. Therefore, this scientist must abide by the rule of collective responsibility, which means that this absolute loyalty should also be reflected in the research results.
Of course, against this background of expectations, autonomy is no longer guaranteed.
The loss of trust between scientists and politicians is so significant that government officials prevent even high-ranking public health representatives from speaking to reporters, even on topics that have nothing to do with COVID-19.
For example, researchers from Public Health England (PHE) and cooperating institutions found that the antibody tests purchased by the Government for Boris Johnson’s favoured prestige project, the controversial and costly Moonshot mass screening operation, fell far short of the manufacturers’ promises of performance.
This study was the first independent evaluation of these tests. The authors wanted to publish their findings, which clearly question the accuracy of this leading Covid antibody test, before the Government spends £75m on buying a million of these tests (That means each test costs £75, which was a hefty price even in November 2020 when tests were more expensive). However, the Department of Health and the Prime Minister’s Office blocked their publication until the purchase of the tests was complete.
Source: Covid-19: Government buried negative data on its favoured antibody test. BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4353 (Published 12 Nov 2020)
So much for being guided by science! And the question must also be allowed, what priorities other than test accuracy might have played a role in this deal?
In the meantime, Boris Johnson has refrained from his pet project. A few weeks later, the British Government quietly abandoned plans to invest £100 billion (almost the entire annual budget of the NHS) in a massive expansion of its national testing programme. The ambitious Operation Moonshot programme planned to run 10 million tests a day from the beginning of 2021 to boost economic activity and support a return to normal life through mass testing.
However, this plan would have been on shaky ground if the questionable tests had been carried out, and the measure’s goal would have been jeopardised rather than furthered.
But perhaps the Government changed its plans because the Good Law Project threatened to take the Government to court for ignoring scientific evidence and spending a tremendous amount of public money without transparency in its decision-making.
Source: Covid-19: Government shelves plans to invest £100bn in mass testing. BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4112 (Published 23 October 2020)
Similarly, the publication of another study by Public Health England (PHE), this time on inequalities in the risks and outcomes of Covid infection, was delayed by the Department of Health. A chapter on ethnic minorities was initially withheld and only published as a follow-up report after many protests. In addition, the authors of the report were told not to speak to the media.
With Covid mortality rates four times higher among ethnic minorities in England than the white majority population, it seems insensitive and illogical to delay a study on the subject that is largely uncontroversial. The results confirm what was already known: certain ethnic minorities are more susceptible to diseases like covid. These differences can be partly explained by existing health problems such as diabetes and by living conditions such as overcrowded housing, income disparities and occupational risks. In addition, experiences of racism and mistrust often prevent affected people from seeking timely medical care.
These findings are not new. However, they must be considered in a pandemic to adopt measures intended to minimise the risk of infection, serious illness, and death to the living conditions and support the population in complying with these measures. For example, it is difficult to distance oneself socially when a family member is infected with covid if one lives in a crowded house. Likewise, when unable to work from home, people need to use public transport to get to work, increasing the risk of infection.
But what sense does it make not to publicise such findings? To ignore the obvious? Is it a case of not taking action if the public is not reminded of the problem? What about Public Health England’s duty to ensure that everyone has an equal opportunity to live a healthy life?
Questions upon questions that need to be asked, over and over again, until the idea of responsibility displaces the concept of self-interest and image-building.
Conclusion: Transparency protects against arbitrariness
It is frightening to observe how self-interested politicians use scientific findings that suit them while discarding those that do not serve their personal good. It is unacceptable that the common good should come second or third.
In this new Corona crisis, independent scientific advice is more important than ever. Politicisation or corruption of science must be prevented. Transparency and accountability are needed to achieve this. Conflicts of interest of Government, politicians, scientific advisors and directors of relevant organisations and bodies, and their advisors and staff, must be relentlessly disclosed. The way decisions are being made must be transparent.
The politicisation or suppression of science by autocrats and dictators is well known from history and, regrettably, is becoming commonplace nowadays also in democracies. When the “medical-political complex”, as Abbasi calls this clique of politicians and scientists, suppresses science, it is predominantly for the self-enrichment of the powerful. And, Abbasi argues, the more successful and wealthy the powerful become, and the more they continue to intoxicate themselves with power, the more they suppress inconvenient findings of science. When good science is suppressed, people die.
LL.
My analysis is divided into several areas and includes:
The Failure of the Political Elite in Dealing with Covid in the UK
Consulting the Government: Struggle to be heard and independent
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