Covid Inquiry: DHSC did not plan for pandemic quarantine measures despite 'system overload' warning

DHSC board warned in 2016 of need for quarantine and contact-tracing preparations, inquiry hears
Emma Reed. Photo: Covid-19 Inquiry

By Tevye Markson

27 Jun 2023

The health department did not prepare for the eventuality that it would need to track or quarantine thousands of people if a pandemic broke out – despite concerns being raised about the health system’s ability to do so, the Covid Inquiry has heard.

Emma Reed, who became the Department of Health and Social Care’s director of emergency preparedness and health protection in 2018, said she was not briefed about whether such processes were in place when she started the role, despite warnings the system would be “overrun”.

Reed said she was also not aware of any debates in the department about using quarantines, whether mass, or border closures, to mitigate against a potential pandemic in the decade leading up to the outbreak of Covid in 2020.

These preparations were not made despite Reed’s predecessor Helen Shirley-Quirk warning in a 2016 departmental board meeting on infectious diseases that “it was more likely than not that even a moderate pandemic would overrun the system” and “at the extreme, there would be significant issues if it became necessary to track or quarantine thousands of people”.

Notes from the 2016 board meeting, submitted to the inquiry, reveal Shirley-Quirk said that “a decision to fund high-end quarantine facilities had already been deferred by ministers”. She also raised concerns “about how resilient the somewhat fragmented system would be – especially in light of previous or future funding cuts”.

Reed said she was “aware of" the "issue relating to system overload” but that she felt these concerns were being addressed through boards, systems and procedures that were already in place when she joined in 2018.

Despite the concerns about tracking and quarantining, no update was made to the government’s pandemic influenza strategy, which was published in 2011. The strategy, which is still in place today, says the UK government “does not plan to close borders, stop mass gatherings or impose controls on public transport during any pandemic” – all mitigations which were used during the Covid-19 pandemic.

Reed was asked if anyone in DHSC had questioned this statement in the strategy between 2011 and the outbreak of Covid in 2020 – or whether there was “any debate about the possible necessity of border closings, self-isolation, quarantine, mass quarantine, mandatory quarantine, or anything of that sort”. She replied: “I'm not aware of any conversations on those areas of mitigation, no.”

The strategy said the government would instead “encourage those who are well to carry on with their normal daily lives for as long and as far as that is possible, whilst taking basic precautions to protect themselves from infection and lessen the risk of spreading influenza to others”.

Plans to refresh the strategy “to ensure that UK pandemic influenza preparedness and response policy is accurate and up to date” were deprioritised in November 2019, just a few months before the UK's first cases of Covid were identified, the inquiry also heard.

Reed was also asked about two major pandemic-preparation exercises in 2016 that had also led to concerns being raised about system preparedness.

Exercise Alice – which tested a large-scale outbreak of MERS coronavirus – found there was a need to develop plans around the need for quarantine, self-isolation, collection data from contacts, and more community sampling.

Asked why DHSC had not made preparations in response to the exercise’s recommendations, Reed said the response fell under the remit of NHS England and Public Health England.

Warnings also came from Exercise Cygnus, a cross-government flu pandemic exercise, that the UK was not prepared for the extreme demands of a severe pandemic.

Reed said it was “very clear” from the Cygnus findings that “there was a lot of work that the department needed to do to improve its readiness for a pandemic influenza”.

But government had fully addressed only eight of the 22 lessons identified in the exercise as of June 2020. A joint DHSC-Cabinet Office pandemic flu readiness board did not meet for one year between November 2018 and November 2019 because the government was prioritising work to prepare for a no-deal Brexit.

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