The government’s Covid plan for autumn and winter is written to inspire confidence. It opens with a reminder that hospital admissions and deaths remain well below the levels of previous waves, points to the success of the UK’s vaccine programme and highlights the investment heading to the NHS. It majors on “Plan A” to manage the disease, which boils down to further vaccine roll out, ongoing isolation of positive cases, more support for the NHS and social care, clearer advice and some continuing border controls.
Everyone will of course hope that this confidence is well placed. Covid cases and deaths over the summer were not as bad as some feared, and to head back into a dark winter would be devastating. Which is why the occasional warnings in the plan of continuing uncertainty should be taken seriously. Dangerous new ‘variants of concern’ or significant waning immunity could knock everything off course. The experience of the last 18 months vindicates the sobering judgement that “scenarios which place the NHS under extreme and unsustainable pressure remain plausible”.
While the government’s plan does a fair job of describing how it hopes to manage the pandemic, it is vague on how it might reintroduce new measures if necessary. There is also the possibility that the further interventions it describes as a “Plan B” may not be sufficient, and it is silent on what any Plan C might look like.
The combination of measures in Plan A is a fairly convincing summary of how ministers are managing the virus at the moment – though the government should not set too much store by still-shaky border controls or the Test and Trace system. More detail on how the NHS will be configured to respond to Covid as an endemic disease is needed, as is more action on how to alleviate staff vacancies in social care. But the plan reasonably describes how the government will respond to the best-case scenario winter conditions.
Importantly the plan also briefly recognises the critical task of doing more to vaccinate the rest of the world through vaccine sharing and capability building – though these are drowned out by the prospect of third ‘booster’ shots for UK citizens aged 50+.
But the plan remains largely a description of existing or recently announced activity, like the booster shots and jabs for 12–15 year olds, not a guide to action. There is no framework for ministers to explain how they will weigh up economic, health and social factors, and no equivalent of the “data not dates” mantra that we were told guided ministerial decisions through the spring and summer.
The government has settled on a familiar trigger for tightening measures, its Plan B. Ministers will consider this “if the data suggests the NHS is likely to come under unsustainable pressure”. That makes sense, but unlike the February ‘roadmap’ out of lockdown there is no further detail and no explanation of how ministers and their advisers will assess this danger, or the warning signs that will prompt action. If the government directs the NHS to make another massive redeployment towards Covid activity and again delay elective procedures, for example, then the threshold will be high. If it wants to catch up on the health backlog it will be much lower.
The three interventions contemplated in Plan B are to require mandatory vaccine passports in a small number of settings, to legally mandate face coverings in crowded and enclosed spaces, and to consider advising more people to work from home. Even these are put forward tentatively, which jars with scientific warnings about “the potential for another large wave of hospitalisations” over the autumn.
If the NHS is on the verge of being put under unsustainable pressure, it is not credible to think that such changes – which some other countries include as part of their ‘Plan As’ – will turn the tide of infections sharply enough to sustain the service through the winter months. Johnson will need more tools in his toolbox like movement restrictions, cancelling large events or further income support for self-isolation to rapidly deploy to reduce hospitalisations and deaths.
The prime minister is treading a fine line between the advice he will be getting from his chief medical officer – notably cautious in recent media appearances – and from his chief whip who has to deal with political pressure from cabinet ministers and increasingly restive government backbenchers. It is the latter consideration that stops Johnson setting out a more comprehensive suite of fallback measures.
Rebellious MPs, and perhaps the prime minister himself, fear that if the government shares a Plan C then it is more likely that such a plan will be deployed, so the closest the prime minister can get to levelling with the public is that “it is not possible to give guarantees” and that “more harmful economic and social restrictions would only be considered as a last resort”.
Part of the prime minister’s job is to point the way to his vision of an optimistic future, and the success of the vaccine programme gives the government good reason to focus on the positives. The government’s reluctance to promote draconian measures is a reason to be encouraged, but after 18 months of painful restrictions Johnson should spend more time describing what his government would do if the worst happened than assuring his party about what it won’t. The plans announced this week could collapse quickly if the pandemic once again races ahead of the government’s capacity to respond.