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A picture of the National Audit Office logo
Initial learning from the
government’s response to
the COVID-19 pandemic
Cross-government
REPORT
by the Comptroller
and Auditor General
SESSION 2021-22
19 MAY 2021
HC 66We are the UK’s We support Parliament
independent in holding government
public spending to account and we
watchdog. help improve public
services through our
high-quality audits.
The National Audit Office (NAO) scrutinises public spending
for Parliament and is independent of government and the civil
service. We help Parliament hold government to account and
we use our insights to help people who manage and govern
public bodies improve public services.
The Comptroller and Auditor General (C&AG), Gareth Davies,
is an Officer of the House of Commons and leads the NAO.
We audit the financial accounts of departments and other
public bodies. We also examine and report on the value for
money of how public money has been spent.
In 2019, the NAO’s work led to a positive financial impact
through reduced costs, improved service delivery, or other
benefits to citizens, of £1.1 billion.Initial learning from the government’s response to the COVID-19 pandemic Cross-government Report by the Comptroller and Auditor General Ordered by the House of Commons to be printed on 17 May 2021 This report has been prepared under Section 6 of the National Audit Act 1983 for presentation to the House of Commons in accordance with Section 9 of the Act Gareth Davies Comptroller and Auditor General National Audit Office 13 May 2021 HC 66 | £10.00
Lessons learned reports
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010746 05/21 NAOContents This report can be found on the
National Audit Office website at
www.nao.org.uk
If you need a version of this
report in an alternative format
for accessibility reasons, or
any of the figures in a different
Foreword by the Comptroller format, contact the NAO at
and Auditor General 4 enquiries@nao.org.uk
Summary of learning 6
Introduction 8
Risk management 12
The National Audit Office study
team consisted of:
Transparency and public trust 16
Leon Bardot, Heather James,
Data and evidence 19 John Fellows, Pauline Ngan
and Alberto Vanzo under the
Coordination and delivery models 23 direction of Sian Jones.
Supporting and protecting people 27
Financial and workforce pressures 30
Appendix One 34
Appendix Two 37
For further information about the
National Audit Office please contact:
National Audit Office
Press Office
157–197 Buckingham Palace Road
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www.nao.org.uk
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you require any of the graphics in another format, we can provide this on request. Please email us at www.nao.org.uk/contact-us4 Foreword Initial learning from the government’s response to the COVID-19 pandemic
Foreword by the Comptroller
and Auditor General
The scale and nature of the COVID-19 pandemic The COVID-19 pandemic has stress-tested the
and the government’s response are without government’s ability to deal with unforeseen events
precedent in recent history. The pandemic continues and potential shocks. Government has often acted
to be a major challenge for government, public at unprecedented speed to respond to a virus which
sector bodies, as well as people across the UK and has caused dramatic disruption to people’s lives,
worldwide. Many people have died, and many lives public service provision and society as a whole.
have been adversely affected. The overall long-term Government had to continue to deliver essential
impact and cost of the pandemic remains uncertain public services, while reprioritising resources to
but will be substantial. deliver its response to the COVID-19 pandemic and
supporting staff to work from home. In its response,
To date, the National Audit Office (NAO) has
government has had to streamline decision-making,
published 17 reports focusing on key parts of the
work across departments and public bodies and
response where there is scope for government to
use a range of delivery structures. Departments will
learn lessons from this experience about how it does
need to reflect on the lessons learned to ensure that
and should operate. This report brings together our
they capitalise on the benefits and opportunities
initial thoughts on this learning across six themes:
these new ways of working have brought.
• risk management;
While the response to the pandemic has provided
• transparency and public trust; new learning from both what has worked well and
what has not worked well, it has also laid bare
• data and evidence; existing fault lines within society, such as the risk
of widening inequalities, and within public service
• coordination and delivery models;
delivery and government itself. The relationship
• supporting and protecting people; and between adult social care and the NHS, workforce
shortages, the challenges posed by legacy data and
• financial and workforce pressures. IT systems, and the financial pressure felt by parts
of the system all require long-term solutions.Initial learning from the government’s response to the COVID-19 pandemic Foreword 5
The challenges posed by the pandemic have This report provides our initial thoughts on the
highlighted the importance for government of learning government can draw from its response to
adopting a systematic approach to preparing for date, based on fieldwork which was mostly carried
high‑impact events, evaluating its performance out in 2020. We aim to refine this thinking as we
frequently, and acting quickly on learning continue our work. Government will recognise
points while adhering to required standards of and has already acted on some of these learning
transparency and accountability even in emergencies. points, but given their importance, we reiterate
This goes beyond meeting legal (or audit) them in this report. These issues, as well as more
requirements. It involves adhering to the standards recent developments in the government’s pandemic
that government has set for itself to maintain and response, will be further explored in our future work.
strengthen public trust. Also, if government can And we will continue to draw out lessons from the
build resilience into systems and delivery chains, government’s response to the pandemic to support
and develop consistently robust horizon scanning, its own evaluation of its performance and provide
risk management and operational management Parliament and the public with timely reporting for
capabilities across government, this will help it to cope accountability and learning.
better with future emergency responses while also
improving business-as-usual activities.
Gareth Davies6 Summary of learning Initial learning from the government’s response to the COVID-19 pandemic
Summary of learning
We have identified learning for government from its
initial response to the COVID-19 pandemic across
six themes. Our main messages across these six
themes are set out below.
Risk management
Identifying the wide-ranging consequences of major emergencies and developing playbooks for
the most significant impacts.
Being clear about risk appetite and risk tolerance as the basis for choosing which trade-offs
should be made in emergencies.
Transparency
and public trust Being clear and transparent about what government is trying to achieve, so that it can assess
whether it is making a difference.
Meeting transparency requirements and providing clear documentation to support
decision-making, with transparency being used as a control when other measures, such as
competition, are not in place.
Producing clear and timely communications.
Data and evidence
Improving the accuracy, completeness and interoperability of key datasets and sharing them
promptly across delivery chains.
Monitoring how programmes are operating, forecasting changes in demand as far as possible,
and tackling issues arising from rapid implementation or changes in demand.
Gathering information from end-users and front-line staff more systematically to test the
effectiveness of programmes and undertake corrective action when required.Initial learning from the government’s response to the COVID-19 pandemic Summary of learning 7
Coordination and
delivery models Ensuring that there is effective coordination and communication between government
departments, central and local government, and private and public sector bodies.
Clarifying responsibilities for decision-making, implementation and governance, especially where
delivery chains are complex and involve multiple actors.
Integrating health and social care and placing social care on an equal footing with the NHS.
Balancing the relative merits of central, universal offers of support against targeted local support.
Supporting and
protecting people Understanding to what extent the pandemic and government’s response have widened
inequalities, and taking action where they have.
Providing appropriate support to front-line and other key workers to cope with the physical,
mental and emotional demands of responding to the pandemic.
Financial and
workforce Placing the NHS and local government on a sustainable footing, to improve their ability to
pressures respond to future emergencies.
Ensuring that existing systems can respond effectively and flexibly to emergencies, including
provision for spare or additional capacity and redeploying staff where needed.
Considering which COVID-19-related spending commitments are likely to be retained
for the long term, and what these additional spending commitments mean for long-term
financial sustainability.8 Introduction Initial learning from the government’s response to the COVID-19 pandemic
Introduction
1 In May 2020, the National Audit Office (NAO) 2 The NAO’s reports on the government’s
published its first report on the government’s response to the COVID-19 pandemic cover many
response to the pandemic, an Overview of the of the key programmes, such as the employment
UK government’s response to the COVID-19 support schemes (the Coronavirus Job Retention
pandemic. We noted that this report would help Scheme and the Self-Employment Income Support
identify a risk‑based series of descriptive and Scheme), the Bounce Back Loan Scheme, NHS Test
evaluative reports where government faced and Trace, and the supply of personal protective
particular challenges and there was most to learn. equipment, as well as more cross-cutting themes
Since then we have published a further 16 reports such as procurement during the pandemic and
on the government’s response to the COVID-19 local government finance. A full list of our reports
pandemic, as well as regularly updating the is provided in Appendix One and a list of the
estimated costs of the government’s response recommendations from these reports is provided
on our website.1 in Appendix Two. By the end of April 2021, the
Committee of Public Accounts had held sessions on
16 out of the 17 reports we published. Appendix One
also provides a list of the Committee’s COVID-19
reports that had been published by 1 May 2021.
1 All of the reports are available on the dedicated COVID-19 section
of our website at: www.nao.org.uk/about-us/covid-19/ and the cost
tracker is available at: www.nao.org.uk/covid-19/cost-tracker/Initial learning from the government’s response to the COVID-19 pandemic Introduction 9
3 By the end of March 2021, the estimated 4 This report draws out learning from the reports
lifetime cost of measures announced as part that we have published to date, as well as other
of the government’s response was £372 billion work we have published that covered the COVID-19
(Figure 1 on page 10). The largest programmes, pandemic, such as our good practice guides on
by estimated lifetime cost, are the Coronavirus Job fraud and error and operational delivery,2 our report
Retention Scheme (£62 billion), NHS Test and Trace on The adult social care market in England,3 and our
(£38 billion) and self-employment income support Departmental Overview 2019-20: Department for
(£27 billion). Figure 2 on page 11 highlights the Work & Pensions.4 It sets out this learning across
estimated lifetime costs by lead department, with the six themes:
highest-spending departments being HM Revenue
& Customs (£111 billion), the Department of Health • risk management;
& Social Care (£92 billion) and the Department for • transparency and public trust;
Business, Energy & Industrial Strategy (£59 billion).
• data and evidence;
• coordination and delivery models;
• supporting and protecting people; and
• financial and workforce pressures.
We will continue to draw out learning from the
government’s response to the pandemic from
our future work.
2 National Audit Office, Good practice guidance: Fraud and error,
March 2021, available at: www.nao.org.uk/report/good-practice-
guidance-fraud-and-error/ and National Audit Office, Improving
operational delivery in government: A good practice guide for senior
leaders, March 2021, available at: www.nao.org.uk/report/managing-
operations-senior-leaders-guide/
3 Comptroller and Auditor General, The adult social care market in
England, Session 2019–2021, HC 1244, March 2021, available at:
www.nao.org.uk/report/adult-social-care-markets/
4 National Audit Office, Departmental Overview 2019-20:
Department for Work & Pensions, October 2020, available at:
www.nao.org.uk/report/departmental-overview-2019-20-department-
for-work-pensions/10 Introduction Initial learning from the government’s response to the COVID-19 pandemic
Figure 1
Breakdown of the estimated lifetime costs of the government’s response to the COVID-19 pandemic
by programme, March 2021
The programmes highlighted in this diagram accounted for 79% of the estimated cost of the government’s response announced up to
31 March 2021
Coronavirus
Job Retention
Scheme
VAT measures4 NHS Test
£62bn and Trace
£10bn
£38bn
Vaccines
£10bn Self-employment
income support
£27bn
Universal Credit
£10bn
Total estimated
lifetime cost Devolved administrations
Further health £372bn £26bn
services spend
£14bn
Bounce Back Loan Scheme
Business grant funding 3 £23bn
£18bn
Business rates measures
Rail and bus measures £21bn
£18bn
Personal protective equipment
£18bn
Support for businesses
Support for health and social care
Support for individuals
Support for other public services and emergency responses
Notes
1 Figures are rounded to the nearest billion.
2 The area of each bubble is proportional to the estimated cost of the programme.
3 Business grant funding includes the Closed Business Lockdown Payment, the Innovate UK Business Support Package, the Retail, Hospitality
and Leisure Grant Fund and the Small Business Grant Fund.
4 VAT measures include reduced VAT rates and VAT deferrals, except for the temporary VAT zero rate on personal protective equipment, which
has been included in the personal protective equipment measures.
5 The programmes shown in this diagram account for £294 billion of the estimated lifetime costs of the government’s response. The remaining
cost (£78 billion) relates to support for individuals, businesses, health and social care, and other public services and emergency responses.
Source: National Audit Office COVID-19 cost trackerInitial learning from the government’s response to the COVID-19 pandemic Introduction 11
Figure 2
Breakdown of the estimated lifetime costs of the government’s response to the COVID-19 pandemic
by lead department, March 2021
HM Revenue & Customs, the Department of Health & Social Care and the Department for Business, Energy & Industrial Strategy
accounted for 70% of the estimated costs of the government’s response announced up to 31 March 2021
HM Revenue
& Customs
£111bn
Other lead departments
£12bn Department of
Health & Social Care
£92bn
Ministry of Housing,
Communities &
Local Government Total estimated
£11bn lifetime cost
£372bn
Department for Business,
Energy & Industrial Strategy
£59bn
Department for Transport
£18bn
HM Treasury
Department for
£46bn
Work & Pensions
£21bn
Notes
1 Figures are rounded to the nearest billion.
2 The area of each bubble is proportional to the estimated cost response by each lead department.
3 Spend on responses may not appear in a lead department’s accounts. For example, HM Treasury is the lead department for support
to the devolved administrations (£26 billion). However, these items appear in the accounts of other government departments.
Source: National Audit Office COVID-19 cost tracker12 Risk management Initial learning from the government’s response to the COVID-19 pandemic
Risk management
5 The government’s response to the COVID-19
Learning pandemic aims to protect people from exposure
to the virus, ensure that those infected are cared
for and mitigate damage to the economy. As well
Identifying the wide‑ranging as ongoing risks, such as those related to exiting
consequences of major the EU, government has had to manage the risks
emergencies and generated by the pandemic and the risks associated
developing playbooks for the with its own response measures. The pandemic and
most significant impacts. government’s response so far have highlighted the
importance of carrying out robust risk planning and
being clear about risk appetite and risk tolerance as
Being clear about
the basis for choosing which trade-offs should be
risk appetite and risk made in emergencies.
tolerance as the basis for
choosing which trade-offs should be
Risk planning
made in emergencies.
Identifying the wide-ranging
consequences of major emergencies
and developing playbooks for the
most significant impacts.
6 Government lacked a playbook for many
aspects of its response. For example, pre-existing
pandemic contingency planning did not include
detailed plans for:
• identifying and supporting a large population
advised to shield. The testing of plans and
policies for the identification and shielding of
clinically extremely vulnerable (CEV) people
were not objectives of Exercise Cygnus, an
exercise carried out in 2016 to assess the UK’s
preparedness for an influenza pandemic;Initial learning from the government’s response to the COVID-19 pandemic Risk management 13
• managing mass disruption to schooling on the
Key facts from our published work scale caused by COVID-19. The Department
for Education’s emergency response function
19 was designed to manage disruptions due to
localised events such as floods.
Ministerial directions
published in 2020 No playbook can cover all the specific circumstances
of every potential crisis. Nevertheless, more detailed
planning for the key impacts of a pandemic and
35% to 60% of other high-impact low-likelihood events can
improve government’s ability to respond to future
Estimated percentage of loans emergencies. It may also bring other benefits,
such as creating new relationships and improving
from the Bounce Back Loans
understanding between organisations.
Scheme that may not be repaid
Risk appetite and trade-offs from
5% to 10% acting quickly
Being clear about risk appetite
HM Revenue & Customs’
and risk tolerance as the basis for
planning assumption for the
choosing which trade-offs should
percentage of payments from
be made in emergencies.
the Coronavirus Job Retention
Scheme that were due to
fraud and error 7 Once the scale of the COVID-19 outbreak in
the UK became apparent, the government made
several rapid, large-scale spending decisions and
• employment support schemes. Instead, implemented some measures at pace. For example,
HM Treasury and HM Revenue & Customs the food box deliveries for CEV people were up and
(HMRC) told us they drew on economic running within days of being announced. In a matter
contingency planning designed for financial of weeks, personal protective equipment (PPE) and
rescues, developed following the credit crisis; ventilator procurement were set up, employment
draft policy work on wage subsidy schemes; support and business loan schemes were up and
and lessons learned from other countries, such running, and the campaigns to house rough sleepers
as Germany; and deliver school meal vouchers were designed
and implemented. Government was also quick
• financial support to local authorities, such as to announce unringfenced funding (£3.2 billion
mechanisms for compensating authorities between March 2020 and April 2020) to help local
for a fall in income. The Ministry of Housing, authorities address the financial pressures caused
Communities & Local Government (MHCLG) by the pandemic.
told us it had stress-tested its response to an
economic shock as part of its contingency
planning. However, the economic impact of
the pandemic exceeded the economic shock
assumed for this stress-testing; and14 Risk management Initial learning from the government’s response to the COVID-19 pandemic
8 To enable speed of action, government relaxed • The Department for Business, Energy &
controls and streamlined spending approvals, Industrial Strategy (BEIS), in conjunction with
recognising that this would lead to an increased risk the British Business Bank (the Bank), has
of fraud and error: estimated that between 35% and 60% of
loans from the Bounce Back Loans Scheme
• In designing employment support schemes,
may not be repaid, and this represents both
HMRC acknowledged that it would need to
credit and fraud risks. In March 2021, the
make certain trade-offs between its normal
estimated value of these loans was between
approach of preventing as much fraud and
£16 billion and £27 billion based on loans
error as possible and ensuring grants reached
to date. BEIS and the Bank are working on
claimants quickly. HMRC drew up longlists
estimating what proportion is due to fraud.
of potential controls for both schemes. In
total it identified 42 potential controls for the • By January 2021, the Department of Health &
Coronavirus Job Retention Scheme (CJRS), Social Care (DHSC) had spent £10.2 billion on
of which 24 were implemented by the go-live PPE, with an estimated lifetime cost of around
date and 57 for the Self-Employment Income £15.2 billion. The Government Counter Fraud
Support Scheme (SEISS), of which 38 were Function has assessed a high risk of fraud
delivered by the end of April 2020. HMRC’s in the procurement of PPE. DHSC has yet to
planning assumptions were that between estimate the size of this potential fraud.
5% and 10% of payments from the CJRS
While some controls were relaxed, the overall
and between 1% and 2% of payments from
framework set out in Managing Public Money has
the SEISS were due to fraud and error. In
remained in place throughout the pandemic as the
September 2020, this amounted to between
basis on which accounting officers should make
£2 billion and £3.9 billion for the CJRS and
decisions to ensure that public funds are used in
between £130 million and £270 million for
the public interest.
the SEISS.
9 Government accepted other trade-offs from
• The number of Universal Credit claimants
acting quickly, such as paying higher prices for
roughly doubled in 2020 and the Department
goods than it would have paid before the pandemic.
for Work & Pensions (DWP) suspended some
For example, DHSC experienced increasing global
controls such as face-to-face appointments
competition to buy ventilators and made purchases
to support vulnerable people during lockdown
primarily on the offer’s credibility, not price. It also
and manage demand. Of Universal Credit
paid high prices for PPE because of the global surge
payments, £1.7 billion (9.4%) were overpaid in
in demand for these goods and export restrictions in
2019-20 before COVID-19. DWP accepts that
some countries.
the increased caseload and easements made
to the process of applying for benefits will lead
to a further increase in fraud and error levels.
Post publication this page was found to contain an error which has been corrected (Please find Published Correction Slip)Initial learning from the government’s response to the COVID-19 pandemic Risk management 15
10 Government focused on getting some
Figure 3
programmes up and running quickly, recognising
Ministerial directions published in 2020
that they may need to be amended as they went.
For instance, due to limitations in the datasets
available, initially some 870,000 CEV people were 10 COVID-19-related,
at least partly on
value-for-money
identified centrally as eligible for support to help
grounds
them shield. A further 420,000 were identified
as eligible by 12 April 2020 and another 900,000
people by 7 May 2020. When the Bounce Back
Loan Scheme was launched on 4 May 2020
4 COVID-19-related
on other grounds
(for example, breach
(seven days after it was announced), the Bank of spending limits)
had a reporting portal for lenders, but this
5
required manual data entry for each application. Not related
An automatic reporting functionality was introduced to COVID-19
in mid-June 2020. Governance arrangements of
some programmes were also redesigned during Notes
the response (for example, see paragraph 30). 1 Six ministerial directions were published in 2019 (four on
value-for-money grounds).
2 The total does not include the Prime Minister’s Personal Minute
11 Some departments made good use of issued to the Cabinet Office Permanent Secretary on 28 June 2020
ministerial directions to proceed with programmes to authorise an exit payment.
where they lacked assurance over value for money. 3 The ministerial directions have been categorised by the National Audit
Office. The categorisation has not been agreed with HM Treasury.
Due to the speed at which programmes were being
implemented, accounting officers could not gain Source: National Audit Office analysis of GOV.UK data
assurance over the value for money of several
COVID-19 response measures. These included the
Bounce Back Loan Scheme, the Local Authority
Discretionary Grants Fund and the Retail, Hospitality
and Leisure Business Grants Fund. As prescribed by
Managing Public Money, some accounting officers
obtained directions from ministers to proceed with
these programmes. In 2020, 19 ministerial directions
were published, compared with an average of five
per year between 2017 and 2019 (Figure 3).5
5 Ministerial directions are formal instructions from ministers telling
their department to proceed with a spending proposal, despite an
objection from their permanent secretary. Permanent secretaries, who
are directly accountable to Parliament for how the department spends
its money, have a duty to seek a ministerial direction if they think a
spending proposal breaches any of the following criteria: regularity
(if the proposal is beyond the department’s legal powers, or agreed
spending budgets); propriety (if it does not meet “high standards of
public conduct”, such as appropriate governance or parliamentary
expectations); value for money (if something else, or doing nothing,
would be cheaper and better); and feasibility (if there is doubt about
the proposal being “implemented accurately, sustainably or to the
intended timetable”).16 Transparency and public trust Initial learning from the government’s response to the COVID-19 pandemic
Transparency and public trust
12 In responding to a new virus and global
Learning pandemic, government faced exceptionally
challenging circumstances. The public sector
has needed to respond in unprecedented ways
Being clear and transparent while seeking to maintain and build public trust.
about what government is Central to this is setting clear objectives, being
trying to achieve, so that transparent about what actions were taken and
it can assess whether it is making why, the trade‑offs being made, and providing clear,
a difference. consistent and timely communications.
Objectives
Meeting transparency
requirements and providing Being clear and transparent about
clear documentation to what government is trying to achieve,
support decision-making, so that it can assess whether it is
with transparency being used as a making a difference.
control when other measures, such
as competition, are not in place.
13 Detailed objectives help to ensure that
the success of programmes can be measured.
Producing clear and For example, HM Revenue & Customs (HMRC)
timely communications. agreed clear principles for its employment support
schemes, including that the claim process should
be simple and the grant calculation straightforward.
Although the Bounce Back Loans Scheme achieved
its initial objective of quickly supporting small
businesses, a lack of more detailed scheme‑specific
objectives will make it difficult to measure its
ultimate success.Initial learning from the government’s response to the COVID-19 pandemic Transparency and public trust 17
Key facts from our published work Evidence to support decision-making
148 Meeting transparency requirements
and providing clear documentation
to support decision-making, with
New guidance documents and
transparency being used as a control
updates to existing material
when other measures, such as
published by the Department competition, are not in place.
for Education between
16 March and 1 May 2020
14 Transparency, including a clear audit trail to
support key decisions, is a vital control to ensure
25% accountability, especially when government is having
to act at pace and other controls (for example,
Percentage of contracts competitive tendering) are not in place. On the
with a value over £25,000 ventilator programmes, we found sufficient record
awarded in response to the of the programmes’ rationale, the key spending
decisions taken, and the information departments
pandemic up to 31 July 2020
had to base those on. However, in the procurement of
where the contract awards
personal protective equipment (PPE) and other goods
were published within the
and services using emergency direct awards during
90-day target the pandemic, we and the Government Internal
Audit Agency found that there was not always a
0.07% clear audit trail to support key decisions, such as
why some suppliers which had low due diligence
ratings were awarded contracts. HMRC initially
Spend on communication as
ruled out publishing the details of every company
a percentage of government’s
claiming furlough payments, which might have
expected total investment in
alerted some employees that their employer was
purchasing and manufacturing acting fraudulently.
COVID-19 vaccines for
the UK, deploying them in 15 We found that many of the contracts awarded
England and supporting global during the pandemic had not been published
efforts to find vaccines as at on time. Of the 1,644 contracts awarded across
government up to the end of July 2020 with a
8 December 2020 (£8 million
contract value above £25,000, 75% were not
out of £11,702 million)
published on Contracts Finder within the 90-day
target and 55% had not had their details published
by 10 November 2020. The Cabinet Office and
DHSC acknowledged the backlog of contract details
awaiting publication and noted that resources
were now being devoted to this, having earlier
been prioritised on ensuring procurements were
processed so that goods and services could be
made available for the pandemic response.18 Transparency and public trust Initial learning from the government’s response to the COVID-19 pandemic
17 Communications from government were not
Communications and public engagement always clear and timely. For example:
Producing clear and • guidance on PPE (issued jointly by DHSC,
timely communications. Public Health England and NHS England &
NHS Improvement) changed 30 times up to
31 July 2020, including material and relatively
minor changes. While frequent updates were
16 Effective communication and public
needed to reflect an increased understanding
engagement are crucial to ensuring that COVID-19
of a new virus and a rapidly changing policy
response programmes succeed. Effective
position, social care representatives raised
communication helps achieve policy objectives
concerns about the guidance, including that the
and strengthens public trust by helping the public
frequency of changes made it confusing; and
understand what the government is doing, why,
and what it means for them and their communities. • the Department for Education calculated
that, between 16 March and 1 May 2020, it
• In our work, we found examples of effective,
published 148 new guidance documents and
clear and consistent communications.
updates to existing material. Stakeholders told
For instance, HMRC developed a range of
us that guidance was often published at the
communication and engagement plans for
end of the week or late in the evening, putting
its employment support schemes. It notified
schools under pressure, especially when
self-assessment taxpayers that they may have
guidance was for immediate implementation.
been eligible for the Self-Employment Income
When the guidance was updated, schools were
Support Scheme, reached out to some of the
not always clear what changes had been made.
largest employers to check if they intended
to apply for the Coronavirus Job Retention
Scheme, and worked with ethnic minority
and faith‑based organisations to publicise
the schemes.
• Despite government advertising and
communications relating to NHS Test and
Trace, reported levels of non‑compliance with
self-isolation requirements were high.
• DHSC has acknowledged variation in the
public’s perception of COVID-19 vaccines,
with some groups more hesitant than others.
Designing effective targeted communications
will be important if the optimum level of
vaccine take-up is to be achieved.Initial learning from the government’s response to the COVID-19 pandemic Data and evidence 19
Data and evidence
18 The insight generated through reliable data
Learning is crucial to the way government delivers services
for citizens, improves its systems and processes,
and makes decisions. Our work has repeatedly
Improving the accuracy, emphasised the importance of evidence-based
completeness and decision-making at all levels of government
interoperability of key activity and the problems that arise when data are
datasets and sharing them promptly inadequate. The pandemic has again highlighted
across delivery chains. the role of high-quality data in enabling effective
service delivery, monitoring and improvement.
It has generated new datasets and data collection
Monitoring how programmes processes that can be used to inform future
are operating, forecasting service delivery.
changes in demand as far as
possible, and tackling issues arising Accuracy, completeness and sharing
from rapid implementation or changes of data
in demand.
Improving the accuracy,
completeness and interoperability
Gathering information from
of key datasets and sharing them
end-users and front-line
promptly across delivery chains.
staff more systematically
to test the effectiveness of
programmes and undertake corrective 19 Timely sharing of data has been vital for
action when required. providing front-line services and managing the
response at the national level. For instance, while
the Department of Health & Social Care (DHSC) and
the Cabinet Office ran their programmes to increase
the number of ventilators separately, they worked
toward the same overall targets and exchanged
progress data daily. The Ministry of Housing,
Communities & Local Government (MHCLG)
introduced a monthly survey of cost pressures and
income losses experienced by local authorities
due to the pandemic. Despite some data quality
issues, it provided an important dataset that several
departments have used to shape their responses.20 Data and evidence Initial learning from the government’s response to the COVID-19 pandemic
20 However, timely sharing of data has not always
Key facts from our published work occurred, and legacy IT issues remain challenging:
95% • NHS Test and Trace (NHST&T) publishes a
large volume of data every week which helps
understand the progress of COVID-19 and
Proportion of Self-Employment tracing performance (Figure 4). However, local
Income Support Scheme authorities did not initially have access to all
claimants who were satisfied the NHST&T data they needed to deliver their
or very satisfied with their local pandemic response.
experience up to August 2020
• By 22 March, when shielding was
announced, 870,000 people had been
815,000 identified centrally as clinically extremely
vulnerable (CEV). It took three weeks to identify
Number of clinically extremely and communicate with a further 420,000 CEV
vulnerable people whose people. This was largely down to the challenge
details were passed to local of extracting usable data from different NHS
authorities to check if these and GP IT systems.
people needed help
Figure 4
375,000
Estimated number of people in England
infected with COVID-19, receiving positive tests,
transferred to the tracing service and reached
Number of clinically
by NHS Test and Trace
extremely vulnerable
people who were sent People with COVID-19
1,943,000
letters advising them to (estimated)
shield but did not receive a
follow-up call due to missing Tested positive by
44%
NHS Test and Trace
or inaccurate telephone
numbers provided in Transferred
39%
NHS patient records to tracing
Successfully
32%
traced
Note
1 Data relate to the period from 28 May 2020 to 4 November 2020.
Source: Comptroller and Auditor General, The government’s approach
to test and trace in England – interim reportInitial learning from the government’s response to the COVID-19 pandemic Data and evidence 21
21 In responding to the pandemic, government
has expanded the range of data that it can use for Monitoring performance, flexing
decision-making. For example, MHCLG now has government’s response and
data on the potential scale of the population in forecasting demand
England which either sleeps rough or is at risk of
doing so. At the start of the outbreak, there was no Monitoring how programmes are
systematic national process to collect a wide range operating, forecasting changes
of information from care providers, other than on in demand as far as possible, and
vacant beds (for instance, on levels of personal tackling issues arising from rapid
protective equipment and workforce absences). implementation or changes in demand.
For care homes, a tool commissioned by NHS
England & NHS Improvement (NHSE&I) in 2019 23 Government has been able to take remedial
was adapted and expanded, and data have been action to address some issues arising from rapid
collated since early April 2020. Government has implementation, and improve performance.
also taken steps to improve the quality of its data. For example, the Department for Education and its
For example, NHST&T received advice from the contractor acted quickly to solve initial problems
Office for National Statistics and a rapid review by experienced by schools and families on its free
the UK Statistics Authority. school meal voucher scheme. This resulted in
improved performance. In terms of vaccines,
22 Limitations in the accuracy and completeness
NHSE&I has had to continually review and adapt its
of the data used and collected by government
deployment plans to ensure it could respond to the
have affected some pandemic response measures.
latest information about which vaccines had been
For example, NHSE&I sent letters to all those advised
approved, which groups in society needed to be
to shield. However, missing or inaccurate telephone
vaccinated, how many doses of vaccines would be
numbers within NHS patient records meant that the
available, and when and how those vaccines needed
shielding programme could not follow up these letters
to be deployed. The Department for Digital, Culture,
with calls to some 375,000 CEV people. While it was
Media & Sport adjusted elements of its response to
known to all parties that a proportion of telephone
take account of the pandemic’s progression and the
numbers in NHS records were missing or inaccurate,
impact it has had on the arts and culture sector.
the shielding programme agreed to use telephone
numbers from NHS records as a starting point to
follow up hard-copy letters. The Government Digital
Service shared with local authorities the contact
details of people that could not be reached, so local
authorities could check if these people needed help.
Local authorities also struggled with inaccurate
contact information.22 Data and evidence Initial learning from the government’s response to the COVID-19 pandemic
24 Data limitations affected the government’s • The staff utilisation rate for contact tracers
ability to assess the effectiveness and value for fell to under 1% in August 2020. NHST&T
money of some measures, which made it harder was initially unable to reduce staffing levels
to adapt its response and manage the risks of to meet its target utilisation rate of 50% due
rapid implementation: to lack of flexibility in contracts. The utilisation
rate then rose, ranging between 10% and
• MHCLG attempted to collect data from local
56% in October 2020.
authorities on basic care provision for CEV
people but was unable to identify a workable • NHST&T did not predict the scale of
solution acceptable to local authorities by increased demand for COVID-19 testing
the end of July 2020, when the programme in September 2020, when schools and
ended. Local authorities reported that bringing universities reopened, and could not satisfy the
together data on basic support provided by a demand for tests until mid-September 2020.
mix of local authority and voluntary groups was
too burdensome. In the absence of these data, Validating interventions by gathering
MHCLG accepted that it had some assurance end‑user feedback
that local authorities were meeting basic needs
given that local authorities had provided similar Gathering information from
support for a number of years. Its engagement end-users and front-line staff
with local authorities also gave it some more systematically to test the
assurance that they were meeting basic needs. effectiveness of programmes
and undertake corrective action
• While HM Revenue & Customs (HMRC) monitored
when required.
the take-up rate of the Self‑Employment Income
Support Scheme among different age and
gender profiles, it does not have data to 26 Gathering feedback from end-users and
monitor take-up rates among different ethnic front-line staff is essential for monitoring the
groups, as these data are not necessary for effectiveness of interventions and improving
the administration of taxes. existing processes. For example, HMRC carried out
surveys of employers, employees and self-employed
25 Government’s ability to forecast changes
people who accessed the employment support
in demand, and to update programmes based on
schemes. The high satisfaction scores recorded
updated demand, has been variable:
gave HMRC confidence that it was delivering a good
• During March 2020, in response to changes customer experience to claimants. On the other
in planning assumptions approved by the hand, while NHS provider organisations told us they
Scientific Advisory Group for Emergencies, were always able to get the PPE needed in time, this
NHSE&I revised down its estimate of the was not the experience reported by some front-
peak number of ventilator beds that could be line workers, particularly Black, Asian and minority
needed. In April, based on the lower demand, ethnic staff. Public Health England’s stakeholder
ministers adopted new targets for the ventilator engagement to better understand the impact of
programme to provide additional resilience COVID-19 on Black, Asian and minority ethnic
in the system and prepare for a potential groups reported deep concerns about the support
second wave. that these workers in health and care settings
received, stating that “it was recognised that a lot
has been done since the start of the pandemic
to improve access to PPE and mitigate risk, but
concerns were expressed that these safeguards
were not applied equally across ethnic groups”.Initial learning from the government’s response to the COVID-19 pandemic Coordination and delivery models 23
Coordination and delivery models
27 The pandemic response has involved
Learning extensive coordination between departments,
arm’s-length bodies, local and national government,
and public‑private collaboration. Delivery chains
Ensuring that there is have often been complex and involved multiple
effective coordination and actors. Against this backdrop, setting out effective
communication between governance arrangements, with clear responsibilities
government departments, central and accountabilities, is vital to delivering outcomes.
and local government, and private
and public sector bodies. Cross-government coordination and
public-private collaboration
Clarifying responsibilities
Ensuring that there is effective
for decision-making, coordination and communication
implementation and between government departments,
governance, especially where central and local government, and
delivery chains are complex private and public sector bodies.
and involve multiple actors.
28 The pandemic response involved examples
Integrating health and social of effective cross-government and public-private
care and placing social care sector collaboration:
on an equal footing with
the NHS.
• Policy and operational staff at HM Revenue
& Customs (HMRC) and HM Treasury (HMT)
worked closely to develop the employment
Balancing the relative merits support schemes, with HMT leading on policy
design and HMRC leading on administrative
of central, universal offers
design, implementation and administration.
of support against targeted
local support. • The Ministry of Housing, Communities & Local
Government’s (MHCLG’s) initial engagement
with local authorities on supporting clinically
extremely vulnerable people to shield was
directive rather than consultative. It recognised
that it needed to improve engagement with
local authorities and moved to a collaborative
approach. The small number of local authorities
we spoke to criticised government’s engagement
with them in the first few weeks of the initiative,
with some noting that engagement improved
over summer.24 Coordination and delivery models Initial learning from the government’s response to the COVID-19 pandemic
Key facts from our published work Figure 5
Organisations involved in purchasing,
17 manufacturing and deploying vaccines in England
Access to vaccines and manufacturing capability
Lead departments involved
in the COVID-19 response Prime Minister • Overall direction and strategy
which had an estimated Vaccine • Identifying vaccines, securing access
Taskforce
lifetime response cost of • Developing manufacturing capacity
more than £1 million, as of • Enhacing ability to deliver rapid
clinical trials
end of March 2021
Pharmaceutical • Developing and manufacturing vaccines
companies
More than 7 Deploying vaccines
Joint Committee • Advising on priority groups for vaccination
Organisations involved in on Vaccination
an Immunisation
purchasing, manufacturing
and deploying vaccines Medicines and • Approving vaccines for use
Healthcare
in England products
Regulatory
Agency
4.7m NHS England
& Improvement
•
•
Operational delivery of the deployment
Administering vaccines
Number of food boxes delivered Public Health • Storing and distributing vaccines
to clinically extremely vulnerable England
• Supplying other goods
people between 27 March and (for example, syringes)
1 August 2020 through private
Source: Comptroller and Auditor General, Investigation into preparations
sector contracts for potential COVID-19 vaccines
• The Cabinet Office worked with industry to
develop new, or modify existing, ventilator or Responsibilities for decision-making,
anaesthesia machine designs to meet standards implementation and governance
that the Medicines and Healthcare products
Clarifying responsibilities for
Regulatory Agency developed for rapidly
decision-making, implementation
manufactured ventilators, and to increase
and governance, especially where
manufacturing capacity to build each design at
delivery chains are complex
a much greater scale than usual. This involved
and involve multiple actors.
securing new factory capacity for each design,
managing global supply chains and ensuring
regulatory approvals were in place.
• The purchase, manufacturing and deployment of
vaccines involves extensive cross-government
and public-private collaboration (Figure 5).Initial learning from the government’s response to the COVID-19 pandemic Coordination and delivery models 25
29 Effective governance and clear responsibilities
and accountabilities are important for an effective The relation between health and
rapid response in an emergency. For example, the social care
Department for Work & Pension’s (DWP’s) clear
Integrating health and social care and
prioritisation of paying benefits and suspension
placing social care on an equal footing
of other activities enabled it to process an
with the NHS.
unprecedented number of claims during the first
lockdown. This was supported by clear governance
within DWP. On the other hand, we found that several 31 Issues predating the pandemic made
organisations had responsibility for approving, responding to the crisis more difficult in some areas.
maintaining and distributing personal protective The relationship between adult social care and the
equipment (PPE) from the pandemic influenza NHS has been challenging for decades. We have
stockpile. There were issues with warehousing, reported on successive efforts to integrate the
logistics and quality of stock. two sectors: there have been 12 government white
papers, green papers and consultations, and five
30 Government has modified the independent reviews on integration over the past
governance arrangements of key pandemic 20 years. Certain aspects of the initial pandemic
response programmes: response reflected a greater emphasis on health
than on social care. For example, national bodies
• NHS Test and Trace (NHST&T) initially had an
initially provided more PPE support to hospitals
unusual organisational relationship with the
than to social care. NHS trusts received 80% of
Department of Health & Social Care (DHSC).
their estimated PPE requirement through national
Although NHST&T was subject to DHSC’s
schemes between 20 March 2020 and 31 July
financial, information and staffing controls, its
2020, whereas social care providers received
head, the executive chair, did not report to the
10% of their estimated requirement (based on
DHSC’s ministers or permanent secretary, but
the information available at the time).6 DHSC told
rather to the Prime Minister and the Cabinet
us that it took different approaches to providing
Secretary. Since NHST&T is embedded within
PPE to social care and trusts during the pandemic.
DHSC, these dual reporting lines brought risks
Social care providers, which are mostly private- or
of unclear accountability. We did not undertake
voluntary‑sector organisations, either obtained PPE
a systematic review to determine if these risks
from wholesalers (as they did prior to the pandemic)
had materialised and had seen no evidence
or from local resilience forums and DHSC’s helpline,
that they had.
which it set up to respond to emergency requests,
• In September 2020, a faster process whereas trusts received PPE directly from the
for approving vaccines expenditure was cross‑government PPE team set up by DHSC.
introduced by government and the governance
for vaccines activities was revised. DHSC
appointed a single senior responsible officer
to oversee deployment to create a unified
programme to reduce duplication, streamline
responsibilities, facilitate cross-departmental
working, and increase transparency
and accountability.
6 Distributions to trusts include a very small volume of PPE delivered to
other healthcare settings.26 Coordination and delivery models Initial learning from the government’s response to the COVID-19 pandemic
32 In responding to the pandemic, DHSC • in May 2020, the government launched NHST&T,
has increased its focus on social care. DHSC bringing together a national programme
outlined how, under the current Care Act 2014, for testing and tracing. By July 2020, local
its oversight of the social care market had been authorities had started to set up their own
limited. Stakeholders reported DHSC’s limited locally run contact tracing schemes to cover
engagement with, and understanding of, the sector the minority of cases that the national service
going into the pandemic. Prior to COVID-19 there could not reach, working in conjunction with
was no process in place to collect a wide range NHST&T. In August, NHST&T reduced the
of data from providers regularly. In response to number of national-level contact tracers and
COVID-19, DHSC has increased the data it obtains designated a proportion of its specialist tracing
on care providers and it intends to legislate for staff to work exclusively to facilitate those local
new powers to collect further data. As part of its authorities that had their own scheme. By the
adult social care winter plan, DHSC carried out a end of October, 40% (60) of local authorities
review of risks to local care markets and service had a scheme in place, with a further 46% (69)
continuity issues, offering targeted support. It also planning to set one up; and
re-established a director‑general post with sole
responsibility for social care, increased its policy • while the Culture Recovery Fund accepted
applications from across England, one of its
team threefold and set up specific teams to provide
goals was to help ‘level up’ cultural resources
support and challenge to local government on the
for deprived communities. This was reflected
COVID-19 response.
in the funding criteria. An analysis by the
Department for Digital, Culture, Media & Sport
Central and local delivery models found that the 10% of local authorities most
in need of levelling up were more successful in
Balancing the relative merits of central,
their grant applications than those least in need.
universal offers of support against
targeted local support. 34 Universal offers of support can be developed
at speed but may not always be as cost-effective
as targeted offers. A government review of the
33 Pandemic response measures have employed
shielding programme concluded that, due to
a combination of universal offers and targeted
the speed and context in which the programme
delivery models. For instance:
was developed, it was largely offered universally,
• the Everyone In campaign was rolled out across resulting in poor targeting and inefficient use of
England to provide accommodation for all rough funds. The review noted that, should shielding
sleepers. For the winter of 2020, the campaign be needed again, adopting a local support model
was supplemented with a targeted programme could improve flexibility and, potentially, be more
focused on the areas with large numbers of cost-effective.
rough sleepers;You can also read
