Big government is bad for your health

Published by DR ROB SUTTON on


One might have been forgiven, before Covid-19 entered our national consciousness, for thinking our government would be well prepared to handle whatever new illness nature could throw our way. The UK government prides itself on the extraordinary resources it has available and our world-leading healthcare services and research capabilities.

Yet the task of protecting the public from the coronavirus has been worryingly difficult. A Conservative government, early in its term and coming off the back of a decisive general election victory, should have been well placed to direct the national response while maintaining public confidence. But the inconsistent messagingcontradictory strategieswaning public support and party infighting point to a disturbing truth – that more isn’t always better, particularly when it comes to governmental departments.

Such has been the prominence of the fear produced by the spread of Covid-19, it has dominated the agenda of No. 10 and the Department of Health & Social Care (DHSC) for months. Others have piled into the fray, including a range of executive agencies, public bodies, advisory groups and research institutions, each eager to lend its expertise and resources in the fight. Public Health England (PHE) and its associated devolved bodies, the Scientific Advisory Group for Emergencies (SAGE), and the Imperial College Covid-19 Response Team were among the most prominent. The full armament of the British state would be deployed in the battle.

As the myriad of political, scientific and economic challenges posed by Covid-19 became apparent, a new challenge emerged – coordinating the efforts of such an enormous sprawl of organisations, each with competing interests, an independent mandate and limited resources. This, combined with a deeply human failing – the desire to receive praise whilst evading blame – has resulted in an organisational conglomerate lacking a unifying mission and whose constituent bodies desperately point the finger at each other when things go wrong.

PHE fell victim to this warped incentive structure. The scandal following the revelation that they included all previously infected coronavirus patients who had subsequently died (regardless of whether they died as a result of the infection) in their Covid-19 death toll was enough for Matt Hancock to announce the disbanding of the organisation. To be fair to them, pandemic responsiveness had never really been within their purview – getting people to quit smoking and steering kids away from junk food was more their level. But with public frustration at the handling of the response, when the axe needed to fall, they were under it.

With the risk of becoming a scapegoat hanging over these organisations, it is hardly surprising that there is little unity shared between them. Instead of directing a coherent response to the pandemic, they must be wary of taking on too much responsibility lest they fall foul of public opinion. So caution takes the place of ambition, and risk-aversion the place of leadership.

Not that this will greatly affect the landscape of public bodies. The government’s response to an already unwieldy corpus of health organisations has been to add more. The new Joint Biosecurity Centre “brings together the UK’s leading data analysis and epidemiological expertise with the aim of ensuring that outbreaks of coronavirus are detected and brought under control quickly.” As though the reason for the underwhelming management of the pandemic thus far was due to a lack of resources.

The real problem is one which plagues every government which grows too large and spreads too thin – institutional inertia, hierarchical uncertainty and unclear remit are multiplied and inhibit a coordinated response. The problem is not that we do not have the resources to handle the current pandemic – it’s that we lack the ability to effectively steer the ones we already have. Having too many fingers in the pie means those organisations which have for years enjoyed the spoils of the public purse are quick to withdraw when the time to accept responsibility comes.

Leadership requires those at the top of government to accept the blame when things do not turn out as planned. It is difficult to make a case that the handling of the current pandemic has been optimal, yet with so many different players involved, it is difficult to see who was responsible. Certainly, there is an aspect of political strategy to this: no-one wants to be the head that falls, and organisational bloat dilutes individual responsibility and reproportions blame. But cynical games like this do little to win public confidence, and ultimately risk lives by producing sub-optimal outcomes. A smaller, more agile team could have vastly outperformed the leviathan of organisations dabbling in the response. Big government is bad for your health.


Rob Sutton is a Junior Doctor in Wales and a former Parliamentary Staffer. He is a recent graduate of the University of Oxford Medical School.