Five years since Covid: four ways government has changed

The government has not prepared the NHS for the next pandemic

From the onset of the pandemic, the entire country was acutely aware that the NHS would struggle under the weight of Covid. The government instructed the public to stay at home to “protect the NHS” and chose to urgently discharge patients from hospital beds into care homes to free up hospital beds. While it prioritised responding to Covid, NHS performance on its typical activity – elective care, cancer care and urgent and emergency care – declined precipitously.   

Most NHS performance has not recovered after the pandemic, having already declined substantially between 2010 and 2019. Record numbers of people waited more than 12-hours in A&E departments in 2024: 1.8 million up from 477,000 in 2019. In December 2024, only 58.9% of people in need of elective care had been on the waiting list for less than 18 weeks, compared to 83.7% in December 2019 and the government’s target of 92%. In general practice, only 71.9% of patients reported being satisfied with their GP practice in 2023, down from 82.9% in 2019.  

The government’s management of the NHS has changed in some ways since the pandemic, and in others returned steadfastly to pre-pandemic patterns.  

Motivated by ministers’ frustration with the lack of levers in the Department for Health and Social Care (DHSC) during the pandemic, the government took more powers back into the department with the 2022 Health and Care Act. That arguably laid the groundwork for the Labour government’s decision last week to abolish NHS England (NHSE) and put even more powers in the hands of the secretary of state.  

A striking feature of talking to NHS staff after the worst of the pandemic, was that they often described feeling more empowered than ever during Covid, as the government encouraged staff to do whatever it took to respond to the pandemic and turned on the funding taps. The result was a flurry of innovation and new ways of working across the NHS. Since then, the government has returned to its usual habits of micro-managing from the centre by trying to tightly grip every pound spent. 

There was an enormous exodus of staff from the service from mid-2021. Those staff have been replaced with less experienced counterparts, a contributing factor to lower hospital productivity. There is also some evidence of more complex demand for NHS services since the pandemic. Finally, there are still spikes of Covid cases, putting ongoing pressure on hospital beds. Pressure exacerbated by the fact that bed occupancy is still above 90% and that the condition of the hospital estate has only deteriorated further since 2020. 

The government may have managed to “protect the NHS” through the worst of the pandemic, but it has done little in Covid’s aftermath to prepare the system for the next global pandemic.

Schools are still feeling the impact of the pandemic

Few public services faced greater upheaval during the pandemic than schools. Primary school attainment was particularly affected by the closures, falling from 65% to 61% between 2019 and 2024. ¹⁶ https://explore-education-statistics.service.gov.uk/find-statistics/key-stage-2-attainment  At Key Stage 4 (KS4), attainment has remained broadly stable at a national level, which is somewhat built into the measure. But disparities across the country have widened. Our new report looks into what drives this local variation in educational outcomes. 

Disadvantaged children were among the worst affected – they were less equipped for learning at home on average and also less likely to receive online lessons. ¹⁷ https://www.gov.uk/government/publications/learning-during-the-pandemic/learning-during-the-pandemic-review-of-research-from-england#the-differential…  As a result, the gap in attainment between disadvantaged and non-disadvantaged primary school pupils has widened to levels last seen in 2015. ¹⁸ https://explore-education-statistics.service.gov.uk/find-statistics/key-stage-2-attainment  And disadvantaged pupils’ GCSE results are on average worse than they were pre-pandemic, while their better-off peers’ have improved. ¹⁹ https://explore-education-statistics.service.gov.uk/find-statistics/key-stage-4-performance  

Children’s early years were also affected, with groups of children who were already persistently behind their peers falling further behind. The development gap between children with and without SEND has increased, from a 52 percentage-point (ppt) gap in 2018-19) to a 56 ppt gap in 2023-24. Likewise, the development gap between children eligible for free school meals and those who are not has widened from 17 ppts in 2018-19 to 19.6ppt in 2023-24. ²⁰ This is defined as the difference in the share of children in these groups achieving a good level of development at Early Years Foundation Stage Profile. This is Institute for Government analysis of Department for Education, ‘Early Years Foundation Stage Profile Results’, 2018-19 and 2023-24.

In 2021-22, absence rates hit their highest levels since at least the early 2000s. Rates have since fallen slightly, but are far from recovery. In 2023-24, pupils at state-funded schools missed an average of 7.1% of sessions, compared to 4.7% in 2018-19. The IfG’s forthcoming case study on how the last Labour government tackled high absence rates in the late 1990s shows that prevention is possible, and that government can address root causes to improve complex outcomes.

The civil service showed that it is capable of real and rapid change

The civil service grew by 51,820 (12%) in the two years over the course of the pandemic, reaching 478,310 in March 2022 as more people were brought in to tackle the enormous challenges facing the state. Pandemic pressures not only increased recruitment, but also drove a peak in appointments made by exception, with a third of all appointments in 2020/21 being made outside the normal civil service recruitment rules. Those exceptional appointments were a temporary phenomenon, as the figure has now fallen below pre-pandemic levels. As well as higher staff numbers, covid brought change to how the civil service works. Regular working from home has become the norm, and cross-departmental digital collaboration – a long-time source of frustration – has improved thanks to the Government Digital Service’s ‘Project Unblock’. Some Covid projects, such as the furlough scheme and the vaccine taskforce, provide lessons for new types of delivery model. 

Covid led to structural changes at the centre too – the Joint Data and Analysis Centre grew out of the analytical capability brought in during the pandemic, and the National Situation Centre and Resilience Directorate have both been established in the Cabinet Office following the pandemic. The growth in the civil service, especially at the centre, has caused problems. A larger Cabinet Office has meant duplication and at times incoherence and has been a source of frustration for ministers and civil servants alike. The civil service has also become used to being in 'crisis mode' for many years now – there continues to be a need to reset to focus on sustained, long-term policy delivery, albeit recognising that crises, new and old, aren't going away. 

Over the last five years long-standing trends have also continued. Even outside the pandemic the civil service has continued to grow. There are fewer administrative (AA and AO) grades and more middle managers, and at every grade civil servants are being paid less – in real terms – than they were in 2020. Civil servants are still most likely to be based in London (20%), and that becomes increasingly true for more senior roles (64% of the senior civil service). There is good progress on this measure though; almost 22,000 staff have been relocated outside London since 2020, and the Darlington Economic Campus provides good lessons for further relocation. And today’s civil service is more demographically diverse than ever, although there is still work to do in particular on disability and socio-economic background. There have been major machinery of government changes with the creation of FCDO, DBT, DESNZ, DSIT (now the digital centre of government following a further move of Cabinet Office staff last year), and a refocused DCMS. Chris Wormald has taken over from Simon Case as cabinet secretary, and most departments also have a new permanent secretary. The legacy of Covid shows both that there is more to do on government structures and civil service reform, but also that the civil service is capable of real change when the circumstances demand it.

Initial progress on emergency planning and preparedness appears to have slowed down

The pandemic highlighted major failings in the UK’s approach to emergency planning and preparedness, from issues with risk identification and data availability to the failure by some departments to prepare adequately or implement lessons from preparedness exercises. These failures had real costs to individuals and to government finances – in the delays to ramping up testing or the inability of HMT and HMRC to target economic support to the self-employed and small businesses, for example. 

Some improvements have been made over the last five years. The National Situation Centre was set up in Cabinet Office to improve the availability and use of data in crises and has now identified relevant data for many risks identified by the government, making it easier to respond to some recent crises. But there is still a lot of work to be done to improve basic data infrastructure and data sharing across government. During the energy price crisis in 2022, for example, the then government was again forced to use expensive untargeted support mechanisms in the absence of data linking income and energy use.

Another major change has been the decision by the previous government to split out the UK’s central emergency response function – the Civil Contingencies Secretariat (CCS) – into two teams – the COBR Unit, tasked with responding to crises – and the Resilience Directorate, tasked with preparedness. This was in response to the conclusion that the CCS had too often been pulled into responding to emergencies rather than thinking about the next crisis and checking departments were preparing adequately. A new programme of preparedness exercises was also launched. Both moves are highly sensible. But in the absence of additional resources for resilience, it is unclear whether the Resilience Directorate will actually now be better able to check departments are preparing effectively or acting on the findings of exercises. 

Improvements have been made in many areas of government preparedness and emergency planning, but as so often in the aftermath of crises, initial progress seems to have slowed and it is unclear whether what has been done so far will be enough to achieve much better outcomes if a new crisis on the scale of the pandemic hits.

Upcoming IfG research is looking at the role of ministers in crises and how officials can be supported to make better policies at pace.