Gov medical advisors should resign or speak out over England’s failing covid strategy

In September, Jonathan Jones, the permanent secretary of the UK government’s legal department resigned on principle over Boris Johnson’s reversal of decisions relating to Northern Ireland in the Brexit agreement. Lord Keen, the government’s law officer for Scotland then resigned on similar grounds, saying he could not reconcile the new Internal Market Bill with his obligations as a lawyer.

They followed other senior civil servants who had resigned on points of principle this year, some with a departing broadside at practice and expectations they found unacceptable.

Yet, I struggle to think of any recent instances of senior doctors, nurses or scientific advisors with roles in government departments or arm’s length bodies overseeing healthcare resigning on a point of principle that clashed with their medical professional code, their personal principles, with the civil service code, or the Nolan Principles for holders of public office.

Deputy CMO Jonathan Van Tam said on the record at a Whitehall press briefing that “In my opinion, the lockdown rules apply to all and are for the benefit of all” in response to Dominic Cummings reported breach of them. He rarely appeared again afterwards. It was also reported that chief nursing officer, Ruth May was pulled from a press conference for admitting that she would take the same line if asked by journalists.

With the exception of those examples, I struggle to think of any senior scientific, medical or clinincal advisor who has spoken out independently to contradict or challenge decisions or statements by politicians or special advisors, therefore taking the risk of being marginalised, sacked or censured.

Yet the government’s competence, conduct and communications throughout the pandemic response has surely given them much cause for concern.

Reasons to keep quiet

I am a former secondee to both the Department of Health and Social Care and NHS Improvement, and I understand the reasons for not speaking out or walking away when things are going down you don’t support.

First, for those who are on civil service contracts (in the Department or Pubic Health England) the Civil Service Code applies, as does the need for collective decision making and support for the democratically elected government, political impartiality and care with sensitive and confidential information.

You cannot undermine or brief against your own department or minister and expect to stay in post. You know that when you take such roles on. Whilst roles in NHS England and Improvement are notionally exempt, there are still constraints.

Second, scientists and medics in senior government roles understandbly believe they can do more good influencing policy decisions and helping improve communication with the public from inside the tent than from outside. They have to play the game. If they walk, someone else will replace them. If they are too challenging, they risk being marginalised or the role being scrapped altogether.

Third and last, these roles are glamorous, prestigious and interesting – a chance to be “in the room where it happens”. The roles can lead to great career opportunities which beat going back to the slog of frontline clinical or management roles. 

Red lines

But surely there are limits and lines? And surely credibility and solidarity with one’s professional peers back in the service is as important as “managing upwards?”

I also believe, the practice of ministers bringing senior scientific advisors and medics to press conferences, so they can use their expertise both as a boost to their own credibility and as a human shield from criticism, changes the rules of engagement.

Where for instance was and outspoken voice or resignation from government nurses when the nursing bursary was scrapped, the safe staffing guidance National Institute for Health and Care Excellence were developing terminated or the immigration rules changed in a way which would worsen workforce gaps?

Dominic Cummings’ behaviour undermined trust in health protection policy and yet despite the mass defence of his hypocrisy by ministers, no govenment medic resigned or went public with direct criticism.

Health and social care secretary Matt Hancock claimed, with an NHSE director standing mutely next to him, that the government had “thrown a protective ring around care homes” – when this was demonstrably not the case. His statement followed repeated denials of the scale of the problem by officials and ministers.

There have been repeated claims about the “world class” covid Test, Track and Trace policy and the availability and scale of testing which flew in the face of the evidence in plain sight, seemed divorced from any coherent strategy and pursed a delivery model which bypassed existing public health expertise and local leaders in favour of outsourced contracts. Scientific and clinical advisers who watched this nightmare unfold, said nothing - at least publicly.

At the beginning of the pandemic, NHS and social care staff strugged to find enough personal protective requipment of adequate quality. At the same time there were serial public assurances and claims that all was well by ministers. They were not contradicted by those advsiors who will have known from their peers and friends still on the frontline how bad things were.

The way data has been presented not only on testing numbers and care home transfers, but on covid mortality has also at times been economical with the truth. For instance, Whitehall press briefings initially presented data on hospital deaths for patients with positive covid-19 tests (however poorly available) rather than Office for National Statistics data based on death certificates, deaths in all settings or excess mortality. Government scientists and medics, whose stock in trade is reliable data, let it slide and it fell to outside actors to force a change in policy. 

Now PHE (already an executive agency of the DHSC accountable to the health secretary) has been blamed for the pandemic response and will be disbanded in the midst of a public health crisis. The new Health Protection Institute is to be led by someone with no background or training in public health, whilst the NHS Track and Trace body has recruited just one clinician to its top leadership team. Is that not enough to spark a resignation or two?

A blaze of glory

Any doctor, nurse or scientist who has got far enough to be appointed a government advisor would walk straight back into a prestigious well paid job outside government. So why have none put their head above the parapet?

If they have given advice which has been serially ignored or misrepresented they might well have grounds to resign, despite the nostrum that “advisors advise and ministers decide”.

Yet still, no high profile medical resignations, no hard hitting statements in the media from senior medical advisors.

Most recently we have seen NHSE writing out to the nation’s GPs urging them to start seeing patients again, despite the fact they have been consulting throughout the pandemic. This even managed to stir the measured and reasonable Royal College of General Practitioners’ chair Martin Marshall into an understandably outraged response. Antagonising the professional group you want on board and publicly shifting blame onto them might spark some reaction from doctors inside the machine, surely?

I am still waiting for someone to take a leaf out of those government lawyers’ book, or perhaps copy former government children’s mental health advisor Natasha Devon, or Drugs policy advisor David Nutt in getting themselves sacked for speaking truth to power and press.

Remember those professional codes I mentioned? Transparency, candour, impartiality and objectivity are all in there and professional registration still applies at whatever management or policy level medics work.

I think we need appointments processes and employment contracts which make it a duty and freedom to speak out and genuine independence from the politics sacrosanct and require a duty to challenge policy or communications which breach professional principles.

More than that, we need just one or two doctors and advisors to go down in a blaze of glory by calling out the unacceptable.

To quote Australian General, David Morrison “the standard we walk by is the standard we accept”