Power and the Pandemic: The Limits of Command and Control

Paul Corrigan was previously Director of Strategy and Commissioning of NHS London Strategic Health Authority, a Special Advisor on Health to the UK Government, and a non-executive director of the Care Quality Commission. He continues to advise leaders both in the NHS and internationally and is one of the UK’s leading opinion formers on healthcare.

Many of us have lately spent our afternoons watching press conferences in Number 10, waiting to hear what was going to happen to us.

Alongside pronouncements from a powerful central state, from February 2020 we saw the NHS nationally mobilising ICU beds, acquiring ventilators and building new facilities to meet the expected demand for acute care beds.

The Prime Minister promised a “world beating” test, track and trace system, run from Whitehall, that would decide which locations needed to be locked down after speedy central diagnosis.

This all looked to be a recognition that, in a time of crisis, power comes from the centre in the form of command and control.

And yet, so much of this only worked in practice because of the actions taken by the public and at a locality level. And so much didn’t work because this was not understood.

It was the public that were expected to decide whether their coughs and fevers were hay fever or possibly COVID-19.

They could ring 111, but they were then asked for some form of self-testing for temperature and other symptoms. The public were also the people who were required to significantly change their behaviour. Most polls show high public agreement with lockdown as a way of staying safe.

In fact, many people were changing their behaviours before the government told them to.

An unintended consequence of central directions around boosting NHS critical care capacity was the transfer of significant numbers of untested, vulnerable patients into local residential accommodation, effectively spreading the virus into localities.

Conversely, it was the staff of thousands of individual care homes who sacrificed and fought the disease for weeks before national testing regimes caught up with what was needed.

On “test, track and trace”, the national system has so far failed to provide local public health professionals with up-to-date and useful information about outbreaks in their localities.

As we saw in Leicester, a national government can order a local lockdown, but it takes local government to make it work.

The real lessons of the lockdown are that, in the modern world, the centre encounters limitations when solving problems across the country.

You need proactive activity from millions of engaged people, rather than obedience from a cowed population. If you want to appeal to civic pride for people to self-quarantine and not infect their neighbours, then you need civic institutions to mobilise that pride.

Modern society, with its digital relationships, is a much more decentred experience of power.

Many of the issues in the response to COVID-19 so far could have been and can be avoided, if central governments are able to recognise this reality.