Britology Watch: Deconstructing \’British Values\’

3 July 2009

Government response to swine flu: over-complicated by devolution?

In media coverage yesterday of the change in the official response to swine flu from ‘containment’ to ‘treatment’, I was struck by the usual ambiguity as to whether the information provided related to England only or the whole of the UK. For instance, in the BBC News website’s report, it stated: “Andy Burnham, the health secretary in England, said: ‘The national focus will be on treating the increasing numbers affected by swine flu. Cases are doubling every week and on this trend we could see over 100,000 cases per day by the end of August'”. Pleasing that the BBC correctly characterises Andy Burnham as the English health secretary; but then, is the “national focus” one for England only or for the whole of the UK? Probably the latter, as the 100,000 cases per day figure was being talked of as the UK-wide total. But all the same, this got me wondering: how is the response to swine flu being co-ordinated – if at all – between the UK government and the devolved administrations, with their separate responsibilities for health care? And is the apparent failure of the containment strategy in part a consequence of different approaches having been adopted in the different UK nations?

Unlike the radio and TV coverage, the BBC website article did report that, “Scottish Health Secretary Nicola Sturgeon announced similar changes to the flu strategy at a simultaneous briefing in Edinburgh”. So it appeared that there is a single UK-wide strategy and a co-ordinated response across the different health departments. This was even more apparent when I visited the Department of Health [England]‘s and the Scottish Government‘s websites and read their remarkably similar statements on the change in tactics.

After much further investigation, it turns out that the Department of Health [England] has retained the responsibility for drawing up the overall UK strategy for dealing with flu pandemics, along with the lead role in co-ordinating the operational response to any actual outbreak; although the devolved administrations are supposed to put in place their own NHS and civil-contingency systems and resources for responding to any crisis – in line with the UK plan.

As the government’s national framework document puts it: “A ministerial committee (MISC 32), comprising ministers from across central government departments and the devolved administrations, oversees and coordinates national preparations for an influenza pandemic”. Then, in the event of the World Health Organisation declaring that a pandemic has reached phase 4 or higher (currently, we’re on phase 6 for swine flu), the following happens: “the Government’s dedicated crisis management mechanism – the Civil Contingencies Committee (CCC) – [is] activated in support of the Department of Health. The CCC will direct central government activities, coordinate the wider response, make key strategic and tactical decisions on the countermeasures required and determine national priorities. The CCC will be guided by input from central departments and agencies and from local responders through Regional [English] Civil Contingencies Committees (RCCCs) and the devolved administrations. It will work with the national News Coordination Centre to maintain public confidence [i.e. manage the news]”.

So we’re currently in a situation where a nebulous Civil Contingencies Committee is co-ordinating the response UK-wide, in keeping with a pre-established plan, and managing the news in such a way as to maintain morale. No wonder that the English-UK and devolved health departments appeared yesterday to be singing perfectly from the same hymn sheet in their media pronouncements in a display of quite exceptional synchronisation and unity! And that, despite the imminent prospect of 100,000 new cases of swine flu per week, we’re being blandly reassured that we’re now moving in a controlled, pre-planned way from containment to ‘treatment’ – implying that it can be successfully ‘treated’ in the vast majority of cases; whereas, in reality, we’re all just desperately praying that it doesn’t suddenly become much more virulent or resistant to Tamiflu.

But, as I said above, one can’t help wondering whether the failure of the containment approach (surely, prevention is better than cure?) is partly the result of the wheels of co-ordination between the UK central government and the devolved administrations not running as smoothly as yesterday’s united front would have us believe. If you read the national framework document, the sheer number of organisations – international, national-UK, ‘regional’ (English), devolved and local – that are involved in formulating strategies and co-ordinating the response is mind-boggling. Amid this already hugely complicated landscape the fact that the NHS and civil-contingency measures are replicated with slight variations in each of the devolved nations and the ‘English regions’ surely cannot help to streamline processes and ensure that everybody knows what everybody else in the chain of command is supposed to be doing.

Take a look at the section that deals with the different organisational elements involved in each of the devolved administrations (pages 49 to 52). This is a masterpiece of bureacracy-speak, and of bureacracy full stop, with departments, committees, sub-committees, groups, sub-groups, directors, trusts, agencies, directorates, etc. etc. all having a role to play. I can’t prove that having these complicated and distinct organisational schemes in each of the devolved countries has contributed to the ineffectiveness of the containment measures; but they surely cannot help. And it is the case that Scotland is one of the ‘hotspots’ of the disease, in part – allegedly – because no Scottish-Government advice for people to stop travelling to Mexico was given out in the early stages of the outbreak.

But, for the time being, we are supposed to be resting assured that all the UK health departments are acting perfectly in concert according to a well-structured plan. But the only reason they’re able to both act in this way, and be on message to such an extent, is that their actions are being centrally directed by a shadowy Whitehall committee, which is also driving the media communications in such a way as to reassure the populace that ‘the government’ has everything under control.

And one of the principal, and well-tried, weapons of media misinformation at the fingertips of the national ‘News Coordination Centre’ is to imply – to gullible people in England, at least – that everything forms part of a homogeneous UK-wide health-care and emergency-response system. Well, the plan may be UK-wide – and the operational direction currently is, too, now we’re in an advanced phase of the pandemic – but the delivery certainly is not.



  1. Irony at its best. 90 people get swine flu and it starts a world wide frenzy. Millions of people have Aids but no one wants to wear a condom

    Comment by kope187 — 3 July 2009 @ 6.58 am | Reply

  2. Wales and Scotland had their own chief medical officers under the old Welsh/Scottish offices so this issue goes back further than ten years. You seem surprised that we are capable of co-ordination.

    Comment by Hendre — 3 July 2009 @ 8.36 am | Reply

    • I take your point, Hendre. I’m not completely surprised at the degree of co-ordination; but I’m sceptical – given the extension and duplication of parallel organisational structures ushered in by devolution – about how effective that co-ordination has really been, particularly given the existence of a strategy to make a show of unity and consistency in order to reassure ‘the public’.

      When these communication efforts are expressed, for the consumption of English people, in the typical form of obfuscation about which functions and facts relate to England exclusively, and which bits are UK-wide, then I start to smell a rat. The government is content to let people think the Department of Health alone – as a ‘UK-wide’ department, which it predominantly is no longer – is running the whole show; but it turns out this is being done by the Civil Contingencies Committee that the media has been somewhat silent about: a body that has stepped in to help the DoH improve its co-ordination efforts – improvements made all the more necessary by the organisational splintering brought about by devolution.

      Comment by David — 3 July 2009 @ 9.48 am | Reply

  3. There’s a bit of form in this area, i.e. health rather than contagious diseases specifically.

    During the period leading up to the BSE crisis several officials at the Welsh Office, among them CMO Dame Deirdre Hine, raised questions about MAFF and DH policy and advice in the area of cattle slaughter and meat safety but were rebuffed by Whitehall. (Whitehall basically had a hissy fit and told them to piss off and mind their own business – in civil service speak naturally. All correspondence/communication was reproduced in the Phillips Report but this aspect was not reported on by the London media.)

    So when you imply there should have been a single, central UK response from the very start to deal with swine flu my instinct is to query whether Whitehall could have come up with all the right answers – it certainly hasn’t in the past. In terms of implementation of policy surely a central committee would still be very reliant on the response of individuals on the ground and how they interpret instructions anyway? However this isn’t a matter for cheap point scoring – you’ve raised serious points about devolved responsibilities but I suppose what you see as splintering I see as pluralism (which isn’t necessarily a weakness even with this current scenario).

    Comment by Hendre — 3 July 2009 @ 11.31 am | Reply

    • I’m not sure if I am saying that a unified, Whitehall-coordinated approach would have been better. My real gripe is the way they dress things up as if that is what is happening, involving the blurring of the lines between the UK-wide and England-specific responsibilities of the DoH, coupled with bland reassurances about the threats; along with the regionalisation of the response on the ground in England. I think a ‘pluralistic’ response on the part of four properly national governments co-operating as equals would be better than Whitehall’s colonialism and English-regionalism.

      Comment by David — 3 July 2009 @ 6.05 pm | Reply

  4. Aren’t we getting bogged down with semantics here? Isn’t anybody going to question the issue at a very basic and fundamental level, especially following the claim that “Britain is among the best prepared countries in the world”?

    I quote directly from blog “Passport to Pimlico” – “It’s in the Air”:

    Hum… Is it me? Or, have I missed something? Has everybody been drinking from the “Crazy Well” again? Swine Flu: I was going to categorise today’s missive under the title of “Humour”, but alas I fear it is another one for the “Rant” bucket.

    On 11 June, it was confirmed that the new Influenza virus subtype of the H1N1 strain was indeed a pandemic, by the World Health Organisation. The WHO? Yes, that’s right, the W.H.O.

    I’m no genius, but I do know that older, even ancient viruses have “learnt” that killing the host is not a good idea. From a virus viewpoint, you kill the host and you’ve shot yourself in the foot, so to speak. You’ve lost your home, your breeding boudoir and your mode of transport in one fell swoop. Now the older and wiser viruses are clever chaps. They’ll just stun you a bit. Make you feel groggy for a week or two. Due to the fact that you are not permanently immobilised or, even worse, dead, the virus gets to meet all your chums, your boss, your work colleagues, your lovers, well you get the idea – and all courtesy of you as the viruses’ mode of transport.

    Now new viruses are a totally different ball game. These young chaps, not having had the benefit of experience, tend to have a less subtle game plan. In their eagerness to stamp their mark and shake the world, they are impetuous. Not having had the time to formulate any policies yet, their weapon of choice is the lump hammer. Meet a host, kill a host. “By Gad, this lump hammer’s effective” they think, “We’ll conquer the planet in a matter of months”. Of course, they do not realise that they are eventually going to run out of hosts. It would be tempting to snigger and allow them to carry on with their naïve plan. Well tempting, if we were not the hosts!

    Now, before we get too smug and scoff at our little foolhardy friends, we should ponder our own innate stupidity. Did we not learn anything from history? European explorers have unintentionally wiped out entire populations in the past. I am not suggesting that their original agenda was particularly benevolent towards these populations, but wiping them out with disease was not on the tick list. At the time, of course, the demise of the visited was totally baffling to the visiting conquerors, the “advisors” or whatever Imperialists are calling themselves these days.

    My point is that large tracts of ocean, sea or desert are natural “breaks”. Airborne diseases and viruses cannot handle the trip! They die en route. Historically, populations and their natural immune systems had never experienced these “new” strains. So, out came the lump hammer.

    Today’s modes of transport mean that journeys that would have taken months or years can be accomplished in hours. So why the hell did we allow people to fly out of Mexico? The “new” strain is discovered – you isolate Mexico on Day One. Simple. You accept that the new strain does not recognise border control, but it certainly knows an ocean when it dies trying to wend its way across one. It dies trying, but at least all other continents are saved. It’s not difficult, not with the mind bogglingly advanced communication networks we have straddling the planet.

    No, we have to send reporters in. We fly people to Mexico to have a look for ourselves. We liaise with other people who have just returned from Mexico. We do just about everything we can to assist this new virus. The new virus cannot believe its luck.
    A Scottish couple returned from their honeymoon in Mexico. They were the first reported case in the UK. They were released from hospital. A friend visited them at their home. You’ve guessed it. He caught the virus, and then there were three. Doh! Then an army of reporters clambered to get the story. Doh! And so it goes…
    Gordon Brown said about Swine Flu:

    “We have been preparing for this kind of scenario for many years. Britain is among the best prepared countries in the world. I do urge people to follow the advice from the Department of Health…We, together with the World Health Organisation and our partners in Europe and internationally, will continue to take all the urgent action that is necessary to halt the spread of this virus.”

    Somehow, before the establishment uttered a word, I had the feeling we would somehow be the best prepared in the world. It was just a hunch.
    By the way, I think the advice from the Department of Health to which Gordon refers to is: Always cover your mouth when you sneeze or cough
    Good God! The new virus is quaking in its boots, as it reaches for the lump hammer.

    Incidentally, this very day, 500 new cases of Swine Flu have been announced in the UK. This takes the total up to over 4,000. A large leap from the original 3. I think we know who’s winning this one

    Comment by Stefan III — 3 July 2009 @ 2.53 pm | Reply

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