How prepared was the UK for the coronavirus outbreak?

Ministers and health bosses are facing questions over how well prepared the UK was for the coronavirus pandemic amid mounting criticism of everything from the speed at which lockdown was introduced to the levels of personal protective equipment and testing.

So what planning had there been and was Professor Anthony Costello, a former World Health Organisation director, right to suggest last week that the authorities had been "too slow" to react and that the UK's death toll could become the highest in Europe, reaching 40,000, as a result?

In 2011, the then government set out its approach to a coronavirus-like pandemic in a UK Influenza Pandemic Preparedness Strategy.

Planning was driven in part by an assessment of a "reasonable worst case" scenario and covered the need to stockpile medicines and equipment, and prepare hospitals for a surge in patients with the disease.

This was backed up by a Health and Social Care Influenza Pandemic Preparedness and Response document produced a year later, which drew from the experience of the H1N1 influenza (swine flu) pandemic in 2009.

In 2013, influenza pandemic guidance was issued for local planners which warned of the possibility of school closures in an outbreak.

Public Health England's (PHE) Pandemic Influenza Response Plan was published in 2014 and highlighted procedures for rolling out stockpiles of personal protective equipment (PPE) as well as the use of "just in time" procurement to supplement them.

Then in October 2016, the government ran a three-day exercise codenamed Cygnus that tested the country's ability to handle an influenza pandemic.

The findings from the Cygnus exercise have not been made public, but recent news reports suggested that they revealed a shortage of critical care beds and PPE – and that the subsequent recommendations were not acted upon.

The Government has roundly dismissed those reports and said it was "extremely proactive" in implementing lessons learned from the past, including Cygnus, such as shaping "legislative proposals" that informed the Coronavirus Act.

But Dr Patricia Lewis, research director for international security at think tank Chatham House, said: "The trouble is, if you don't know the results of it how do you know that the lessons learned were applied?"

She said the UK's response preparations needed greater levels of scrutiny, such as a new legal requirement for the Government to report to Parliament every year on the state of national plans.

This would include stock levels of essential equipment, hospitals' ability to cope with a large influx of patients and the findings of any drills or simulations.

Despite saying it has distributed millions of PPE items to health workers, the Government has faced repeated criticism on shortages.

There have been questions over why it had not taken part in an EU procurement scheme and why not all production offers from domestic manufacturers have been accepted.

Health Secretary Matt Hancock has denied that politics were involved in the EU decision, adding that the scheme has not yet made anything available.

He also said checks were needed on offers from UK firms as not all opportunities had been "credible".

Dr Lewis said that PPE shortages were a "really shocking state of affairs" and were one of the basic issues that "parliamentarians need to scrutinise".

She said Parliament's National Security Strategy Joint Committee inquiry into preparing for emerging infectious diseases and bioweapons was forced to close last year as the general election was called.

Dr Lewis said some other countries had so far appeared "better prepared", including South Korea, Taiwan, Vietnam and New Zealand.

Peter Openshaw, professor of experimental medicine at Imperial College, said "really good" preparations under previous Labour governments had helped the bioscience sector respond quickly to the current crisis.

But he said there had been an "underinvestment" in the public health infrastructure and devolution had "fragmented what used to be a world class service".

He added: "I think the capacity we've got in terms of being able to test large numbers of samples would be better if we had scaled up rather than really squeezed the investment over the past few years."

Prof Openshaw said the countries who had done well during the pandemic were those who had "put biotechnology and bioscience high on their agenda".

He suggested that between outbreaks "complacency accrues" among "opinion leaders and the funders", adding that he even had to convince other scientists of the risks posed by Covid-19 in early March.

"At that time, I was lying awake at night unable to sleep, worrying about just how terrible it was looking," he said.

He added: "I don't think it was in any way the politicians who were alone in being complacent at all."

Whether politicians were alone or not, the role of the UK's political leaders in the early stages of the crisis has come under scrutiny.

On Sunday, Cabinet Office Minister Michael Gove was forced to defend Prime Minister Boris Johnson – currently recovering from Covid-19 at Chequers – amid reports he missed five meetings of the Cobra committee, convened to handle matters of national emergency, in the early stages of the current crisis.

Mr Gove said the idea that Mr Johnson had skipped vital meetings was "grotesque", emphasising that his leadership during the crisis had been "clear" and "inspirational".

In the House of Commons on Wednesday, Mr Hancock said the Government was committed to "ramping up" testing and contact-tracing "in a matter of weeks".

But Labour leader Sir Keir Starmer said there was a "pattern emerging" in the Government's response, adding "we were slow into lockdown, slow on testing, slow on protective equipment".

Foreign Secretary Dominic Raab rejected his comments, saying ministers had been "guided by the scientific advice... at every step along this way".

In terms of lessons for the future, Dr Lewis said the Government should reinstate the position of minister for resilience, a role last held in 2018 by Conservative MP Caroline Nokes.

Dr Lewis said: "The trouble is, as we're seeing, if you don't have anyone in charge, you end up with things falling between the cracks."