“The resilience and preparedness of the United Kingdom”
Part 1 – Five flaws
The first module of the Baroness Hallett Inquiry into the Covid-19 pandemic that took evidence between 13 June and 20 July 2023 looked into resilience and preparedness of the UK. Since this is exactly the topic that futurists should be engaged with, we wanted to see whether there were general lessons we could draw from its conclusions that could be applied to “resilience and preparedness” in other organisations and other situations.
Naturally, much of the report deals with “whole-system” events that only governments will be facing. But when a risk as clear as a pandemic has been identified, how the planning for that risk worked – or not – holds lessons for us all.
In this first blogpost, we focus on “risk assessment” and five specific flaws the Report identifies. A second one will look at systems, organisation and planning.
The Report starkly states that “it is not a question of ‘if’ another pandemic will strike but ‘when’” and that “there must be radical reform.”. The government had convinced itself – and indeed others abroad – that it was one of the best-prepared countries in the world to respond to a pandemic. The Report concludes that, in reality, the UK was “ill prepared for dealing with a catastrophic emergency”, let alone the coronavirus (Covid-19) pandemic that actually struck. Clearly this demonstrates a fault that any of us could make – a lack of self-awareness and self-criticism.
Building resilience and proper preparation for a risk costs money. It involves preparing for an event that may never happen. Going into the pandemic, there had been a slowdown in health improvement, and health inequalities had widened. Public services, particularly health and social care, were running close to, if not beyond, capacity in normal times. Organisations that fail to invest in resilience and that run with little spare capacity (ie “efficiently”) are always at risk.
The Report identifies five major flaws in the approach to risk assessment in the UK that had a material impact on preparedness for and resilience:
Too narrow a scenario
Assumed impact, rather than focus on mitigation and suppression
Lack of a system-wide view – feedback and spiral
Failure to understand who was vulnerable; and who was vulnerable to the response
Failure to connect assessment of risk with strategy of dealing with it.
Risk assessment centres on answering:
What could go wrong?
How likely is it to go wrong?
If it does go wrong, what harm will it cause?
Flaw 1 – too narrow a scenario – focus on a “reasonable worst-case scenario”
Too much reliance was placed on a single scenario – pandemic influenza – and on the likelihood of that scenario occurring. The effect was that risk was assessed too narrowly in a way that excluded other types of pandemic.
It is not reasonable to anticipate and plan for everything that could happen. There was a concern that the use of multiple scenarios would have been too resource-intensive. So there was a focus on a “reasonable worst-case scenario” (RWCS) – pandemic influenza – which was a relatively high probability and certainly high impact event.
RWCS have the potential to be interpreted as a prediction rather than as just one scenario against which to plan. Setting out multiple scenarios, up to and beyond the reasonable worst case, should result in more sophisticated planning and a greater range of possible responses. Respiratory diseases such as SARS and MERS had been identified as a risk but no contingency plan seemed to have existed.
The Royal Academy of Engineering suggested that “[L]ikelihood should not be the main driver for prioritisation as this can be difficult to assess with a high degree of confidence across all risks. Decision-making should be driven by impact and preparedness linked to capability across prevention, mitigation, response, and recovery. Less weight should be given to likelihood, since there should be planning for unlikely events too.”
Similarly, Sir Oliver Letwin said that the focus on likelihood was a mistake “because events with huge impacts that are very unlikely and may not occur for many years, if they do occur, will nevertheless have huge impacts”.
Although the Report does not address it, there are ways in which resilience planning can cover a range of scenarios. Rather than going into detail of a particular type of pandemic, planners could consider what would be required regardless of the specific threat – contact tracing, vaccine development, PPE – and what general policies could be enacted. Hospitals generally have a “major incident” plan – generally suspending elective surgery – that can be enacted whatever the cause of the incident. “Risk agnostic” resilience is the goal.
Flaw 2 – accepting the impact rather than mitigating the threat
Planning was focused on dealing with the impact of the disease (in this case, influenza) rather than preventing its spread. As a consequence, the levels of illness and fatalities of a pandemic were assumed to be inevitable and there was no consideration of the potential mitigation and suppression of the disease.
The National Risk Register “ explicitly assumed that in the event of a pandemic large numbers of people would fall ill. It did not mention action that might be taken to prevent this from happening”. The RWCS for pandemic influenza was a largely unmitigated scenario. “[A] good risk register should drive thinking about how risks can be prevented, mitigated, handled if they transpire and to clear up afterwards.”
There is a risk that scenarios are viewed fatalistically rather than used as warnings of futures to be avoided.
Flaw 3 – interconnected risks and “domino effects”
This may be a more specific concern for government and “whole system” threats but it is worth all organisations considering not only second- and third-order effects of change, but the consequences of mitigating actions. “The cure for a specific emergency can have harmful side effects”.
Sir Patrick Vallance said “Many risks are interconnected and can act as contributors or enablers of other risks. This in turn can amplify certain risks. This issue is not currently captured sufficiently well in the [National Security Risk Assessment] methodology.”
A single emergency may create a domino effect in which, when one thing goes wrong, other things go wrong as well.
Different responses to emergencies will have a range of side effects across the system. It should be a fundamental aspect of all risk assessment that all potential impacts are taken into account. Note, that these impacts may not necessarily be all negative – new relationships may be developed, new skills learnt, new opportunities identified.
An analysis of how risks are connected may well be both challenging and resource intensive, but foresight tools such as Futures Wheels can help.
Flaw 4 – Long-term risks and differential impacts
Resilience depends on having a resilient population. The existence and persistence of vulnerability in the population is a long-term risk to the UK. Long-term risks are different from acute risks because they gradually affect resilience over time. An unhealthy population is at significantly greater risk of experiencing higher rates of serious illness and death as the result of an infectious disease.
Covid-19 was not an “equal opportunity virus”. It resulted in a higher likelihood of sickness and death for people who were most vulnerable in society. A quote at the time was “we are all in the same storm at sea, but not all in the same boat”.
Organisations generally may be able to choose which parts of the system to allow to fail, while focus is maintained on existential threats. (Interestingly, the human body itself can behave in this way). But, again, thinking this through in advance will enable an organisation to respond more effectively.
Long-term, chronic risks can often be harder to deal with than acute, more immediate threats. The “boiled frog” apologue shows how it can be difficult to decide when to act. Identifying “trigger points” which are actively monitored can help in this regard.
Flaw 5 – Capabilities and capacity
There was insufficient connection between the assessment of risk and the strategy and plan for dealing with it. This led to a failure to focus on the technology, skills, infrastructure and resources that would be needed to prevent or respond to the threat. We need to ask “what can actually be done in response to an emergency?”.
“If risk assessment does not take into account what is and is not practically feasible, it is an academic exercise distant from those on whom it will ultimately have an impact”. The need is for decision-making to be “driven by impact and preparedness linked to capability across prevention, mitigation, response, and recovery”.
Consideration of capability and capacity can also lead to the development of preventative strategies – drawing in or developing new skills, identifying “surge capacity” and backfill tactics, deliberately maintaining excess capacity.
These five flaws together led to Recommendation 3 of the report: A better approach to risk assessment that moves away from a reliance on single reasonable worst-case scenarios towards an approach that:
assesses a wider range of scenarios representative of the different risks and the range of each kind of risk;
considers the prevention and mitigation of an emergency in addition to dealing with its consequences;
provides a full analysis of the ways in which the combined impacts of different risks may complicate or worsen an emergency;
assesses long-term risks in addition to short-term risks and considers how they may interact with each other;
undertakes an assessment of the impact of each risk on vulnerable people; and
takes into account capacity and capabilities.
Most of these are applicable more widely.
Other failures we’ll look at in Part 2 include:
labyrinthine institutions;
strategy, from 2011, was outdated and lacked adaptability;
failure to learn sufficiently from past;
planning guidance was insufficiently robust and flexible, and policy documentation was outdated, unnecessarily bureaucratic and infected by jargon;
lack of adequate leadership, coordination and oversight. Ministers, who are frequently untrained;
lack of sufficient freedom and autonomy to express dissenting views and a lack of significant external oversight and challenge; ‘groupthink’.
Written by Huw Williams, SAMI Principal
The views expressed are those of the author(s) and not necessarily of SAMI Consulting.
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