You’ll be forgiven if it went under your radar but the UK Government recently issued its response to the first set of recommendations of the UK COVID-19 Inquiry

Designed to improve the UK’s resilience and preparedness for a pandemic, the inquiry called for governments to implement 'radical reform”' through 10 core recommendations. These were published by the Inquiry last July, and the UK Government had six months to respond to these recommendations in full.

We need strong public services

The UK Government’s response, spearheaded by Pat McFadden, is a welcome first step towards making sure that the horrors we witnessed during the COVID-19 pandemic never happen again. In particular, their acknowledgement that strong public services are key to the UK’s resilience will resonate with many of us who worked on the frontline during the pandemic. We know first-hand that better resourced systems, with more staff, beds and equipment, would have helped us to cope better.

It is also positive to see some of the specific measures announced in the response, including a commitment to better map who might be vulnerable in a crisis so that targeted local support can be provided. Given that pandemic preparations didn’t give much consideration to inequalities, with severe consequences for many, this measure is welcome.

But this response is just a first step. We need the commitments to be properly funded, and to start to see tangible change on the ground. The upcoming Spending Review is a well-timed chance to make this happen.

The public health elephant in the room

Importantly, though, we need to ask the critical question of what public services the government are actually talking about here? They seem to be focusing on the NHS, while noticeably not talking about public health systems.

Public health systems entered the pandemic already stretched far too thinly. In the years before Covid-19 we experienced multiple reorganisations, huge funding cuts and staff shortages. In England we also experienced cuts to the ring-fenced public health grant, a fragmentation and reduction of health protection expertise, and reductions in the ability of public health staff to speak independent truth to power. The result? Public health systems entered the pandemic without the resources, workforce, capacity, structures or voice to respond at the scale that was required.

And yet when Pat McFadden was questioned on this by MPs, he conspicuously failed to make any commitments in this area.

Of course, it is vital for healthcare services to be adequately resourced. But to focus on the NHS in isolation from public health systems is to only consider one part of the puzzle. To stand a chance in the next pandemic – and unfortunately there will be a next pandemic - we need both systems to be strong and properly funded. For public health, this means: a reverse of funding cuts made in recent years; an increase in the number of public health staff at a local, regional and national level, placed strategically as well as operationally; an increase in the number of public health medicine training places; the ability of public health leaders to speak independent truth to power without fear of repercussion; and a workforce visible to each other, our partners and our populations.

More needs to be done

The UK Government’s response acknowledged that we entered the pandemic with poor population health and significant health inequalities, which affected the country’s response. This acknowledgement is important, and yet we need tangible action to address the key drivers of ill health more ambitiously.

Since 2020, the amount of time that people spend in poor health has increased, the gap in healthy life expectancy between the most and least deprived areas is now almost 20 years, and the number of working-age people out of work due to ill-health has skyrocketed. With this foundation, acknowledgement alone is not enough.

My view – and that of many members – is that almost five years on from the start of Covid-19, the UK is in many respects in an even worse position to be able to cope with a future pandemic or health emergency. This response is a first step, but now we need the UK Government to take a second - and this time much more ambitious – step towards making sure that we are prepared and that the trauma and devastating experiences of the pandemic will not be repeated.

Heather Grimbaldeston is chair of the BMA public health medicine committee