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COVID-19: The Disunited Kingdom

Vashti Miller and Frances Neilson

As lockdown begins to ease, the MHP Health team considers three of the long-term impacts that the current divergence in strategy could have.

Until this week there has been close alignment between the UK and devolved governments on their responses to the COVID-19 pandemic. With the Prime Minister announcing a partial lifting of some of the lockdown measures from this Wednesday, the different approaches, never far from the surface, have become more apparent. As ‘normality’ slowly returns, plans set out by Whitehall will likely guide those of the devolved administrations, but ultimately health is a devolved matter.

The repercussions of the pandemic will be long lasting and far reaching. We have identified three themes that may go some way to explaining the differences in strategy – and how these in turn could share the future of devolved politics in Britain.

Leadership

With tensions already running high over Brexit, no one expected a global pandemic to also be thrown into the mix of the newly restored power-sharing Executive at Stormont. Much has been made by Sinn Féin of the divergence of policy between Northern Ireland and the Republic of Ireland, but it is too soon to tell if the different approaches have had an impact on the death rates North and South. The DUP’s natural home is to align with Westminster, but the current advice from the Executive remains as ‘Stay Home’ and the published five phase plan for easing the lockdown in Northern Ireland deliberately avoids putting specific dates to the stages.

From the outset, one leader has not been shy about rocking the boat. Deliberately timing her media announcements to brief the outputs of COBRA meetings before the PM from the outset, Scotland’s First Minister, Nicola Sturgeon was unforgiving in joining the Twitterati in condemning the mild relaxation of guidelines in England, in advance of them even being announced. Distancing her approach in Scotland from that of the UK Government’s is a gamble, but one she hopes will demonstrate the benefits of greater divergence if the results of the measures prove more effective in keeping down the number of deaths – which she expects. This, she will hope, will then translate into a resurgence in enthusiasm for IndyRef2.

Mark Drakeford, First Minister of Wales, has a tougher balance to strike; with the Conservative Party gaining a significant number of seats in the UK December election and in Wales, Plaid Cymru providing fierce opposition. The outcome of the Welsh Parliamentary elections are likely to see Welsh Labour in a vulnerable position. A gamble, in the form of a bold pandemic response deviating from that of Boris Johnson’s, could win Drakeford a majority, but one misplaced judgement could damage his reputation. Currently, Drakeford seems to be lacking Sturgeon’s confidence. That has not been helped by his own misinterpretation of the Welsh Government’s guidance at yesterday’s press conference.

Responding to a second wave

The lifting of lockdown measures is conditional to avoiding a second peak in cases; restrictions could be re-enforced again at any time, at the discretion of each devolved administration. While the NHS has remained ‘open’ throughout the pandemic, the continuation of certain services has differed between postcodes, depending on local trusts’ ability to develop COVID-free zones for patients. The resumption of these services, particularly in non-urgent cancer care and diagnosis, offer an opportunity for the devolved administrations to develop innovative solutions and to introduce new measures to address capacity issues that have been intensified by the pandemic. However with preparations for the winter surge in demand already underway, the window to achieve genuine transformation in services is likely to be small.

In Northern Ireland, this poses a particular challenge as prior to COVID-19, cancer services were already facing capacity issues and significant waiting times. Service redesign in the face of COVID-19 coincides with the cancer strategy which is due to be published in November this year. The current environment could provide an opportunity to introduce measures to refine cancer services.

With winter planning now in full swing, there is understandable nervousness across the health systems about a second peak in COVID-19 cases.

The future of devolution

There are obvious benefits to the devolved nations participating in UK wide policies, such as the development of the NHSX contact tracing app, the current furlough scheme funded by the UK Government, and access to evidence from SAGE. However, the complex interplay between devolved and reserved matters is emphasised by the response to the pandemic. Serious difficulties arise through the combination of contrasting approaches and existence of borders. Differing strategies between nations may create confusion amongst the general public and make it more difficult to contain the virus in border areas.

Given the nature of COVID-19 and the highly localised rate of infection, the importance of devolved governance is reinforced by ensuring context-based solutions. However, devolution as we know it does not allow each nation to be truly autonomous, nor does it facilitate a united UK response to the pandemic, which will inevitably raise questions around the current distribution of power.

With elections looming in 2021 and 2022, the future of each nations’ political make up will be impacted by the existing administrations’ responses to the pandemic. How each choose to position themselves in relation to Whitehall’s response may have far-reaching consequences in health and at the ballot box.