DHSC lacked economic advice to support Covid response, ex-minister says

Bethell also criticised No.10’s "odd" approach to managing the pandemic, and argued that government should be like Transformers
Bethell said there was no economic assessment of DHSC's measures to tackle Covid. Photo: Mark Kerrison/Alamy Stock Photo

By Tevye Markson

06 Sep 2023

A former health minister has described the lack of economic advice in the Department of Health and Social Care as his biggest frustration during the Covid-19 pandemic.

James Bethell, who was a minister in the department from March 2020 to September 2021, also bemoaned No.10’s "odd way of running things" during the pandemic; revealed the major departure that made government coordination “better”; and called for the government to be more like the alien-robots in the film series Transformers, in an interview for the Institute for Government’s Ministers Reflect series.

Economic frustrations

Asked how easy it was to access economic advice when he was minister for technology, innovation and life sciences, Lord Bethell said: “I didn’t have any. None. I think that was a mistake, and it was noticeable, and it was a shame.”

Bethell said he had no officially mandated framework or assessment of the economic implications of the department’s Covid-tackling measures, unlike other departments, which “made it difficult to apply formal decision making and made many of the ministerial decisions essentially political, because there was no economic yardstick”.

The peer said he was “quite rightly given a very hard time by peers for coming to the despatch box without proper cost-benefit analysis or economic assessments”.

“I hated doing it, but I had to explain, 'We’re the health department. We’re not the department for economics, or the Treasury'.” 

“I was really surprised that we never got any kind of economic briefing. I asked for it many times.”

Bethell said he tried to come up with his own personal economic thinking for speeches in the House of Lords, but officials had “intervened, quite reasonably and quite correctly", telling him: “It is not your role as the health minister to try to make up the government’s economic policy. The Treasury will go mad if you try to do that, we will not get the speech cleared by their officials, and – by the way – it’s neither smart nor right."

"And they had a point, so that stuff got deleted," he added.

Whilst accepting it would not have been possible to consider the economic impacts of every intervention during a fast-changing global pandemic, he said it “did not help” that DHSC “completely avoided any economic discussion or publishing any economic guidance”.

No.10 'had an odd way and not good way of running things’

Downing Street’s chopping and changing of ministerial roles also came in for criticism during the deep-dive interview, which took place in June and was published today.

Asked about his responsibilities during the Covid response, Bethell said his life-sciences role “changed quite a lot” as Downing Street “would grab things and then give them away”.

“That was an odd, not very good way of running things,” he said.

“At first, it was very amorphous and unclear. Some of it was liaising with the life-sciences industry. At the very beginning, I was doing quite a lot on vaccines, and on testing, and on drugs and clinical trials, and on medicines and medicine preparedness. There was quite a long list. Then different bits got given to me and taken away from me.

“Obviously, the Vaccine Taskforce came in and took that off my desk, and then much later Nadhim Zahawi came in and became the vaccines minister, so that was great. On the other hand, I looked after test and trace all the way through, but then red listing and the border came and landed on my desk. Which was good, because I felt very strongly about it, but it was quite a lot of work.”

Bethell also claimed No.10 did not pay enough attention to the outbreak of Covid in the early months. “No.10 didn’t want to prioritise the pandemic in early 2020, even though the evidence was mounting – there was a post-election, ostrich head-in-the-sand mentality, which I saw again around the invasion of Ukraine,” he said.

“Its priority, and what we were told many times, was Brexit and levelling up. 'We have to deliver Brexit, so could your pandemic quietly go and mind your own business please,' we were told. So we had several weeks of this brushing off, and then they switched into it eventually.”

Officials in DHSC, on the other hand, “[acknowledged] this was going to be a really big thing very early”, Bethell said.

Once Downing Street grabbed hold of the Covid agenda, Bethell says there was “a lot of erratic dipping in".

"In Yiddish, it’s called ‘kibitzing’: erratic and ill-informed interference. 'Put a bit more salt in there. Oh, not that much pepper'."

But he said “coordination within government got a lot better after [former Boris Johnson adviser] Dominic Cummings left”.

Government ‘did not know how to change shape’

Bethell also criticised government’s struggle to transform during the crisis.

“I was very confused about the fact that government did not know how to turn on a coin, to change shape and bring in new people,” he said.

“Maybe I have been in too many agile organisations that routinely change direction as circumstances evolve," said Bethell, who has been a journalist, managed the Ministry of Sound nightclub, and founded a PR firm.

"But this wasn’t the first time Britain had faced a national emergency, obviously, and yet there was seemingly no capability for changing the responsibilities of agencies and departments, of creating new capabilities, or recruiting and reassigning key people.

“For instance, I think [DHSC] doubled in size. But that took a long time, and it should have been made 10 times bigger. For goodness' sake, only 3,000 people to 6,000 people. And it was trying to provide oversight of huge swathes of government decision making”.

Bethell said there were exceptions, pointing to ex-Olympics chief Paul Deighton, who was brought in to boost PPE production; former telecomms boss Dido Harding, who led test and trace; Doug Gurr, former Amazon chief, brought in to advise the government on how it could work with devolved administrations to tackle Covid; and ex-Apple exec Simon Thompson, who was appointed managing director of the NHS Covid-19 App; along with Zahawi as vaccines minister.

But he said he is still confused as to why the department didn’t get "five ministers on day one”.

The UK should take note from countries like Taiwan and build a “Transformer government", Bethell said, comparing government to the media franchise of alien-robots who can change their form.

“Places like Taiwan have pandemic acts, [passed] after 2003, after SARS. And they changed, like in Transformers – Bumble Bee goes from being a car, then he becomes a robot. And he changes shape to fight the enemy, and then changes back after the battle,” Bethell said.

“We should have a Transformer government. [That means] when there’s a war or a pandemic or an electromagnetic pulse that wipes out however many people, the shape of government changes and different decision making gets put in place – and, by the way, we get five more ministers and a load of people come in.

"We face an age of polycrisis. I am surprised we are not taking a pandemic act through parliament to introduce ‘Transformer government’ as they are in other countries.”

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