This report outlines how fragility was built into the UK’s hospital and public laboratory systems so that the Covid- 19 crisis was an accident waiting to happen, a normal accident.

The hospital system did not have the buffer capacity needed to absorb a pandemic surge and the public health laboratory system lacked the organisational capacity to respond to unexpected circumstances. All this was unintentionally caused by a combination of long-term funding shortages and the hyper-innovation of organisational churn imposed on the NHS and public health in the name of public sector reform.

 Beyond this critique, the report addresses remedies and the question of how to rebuild so that we have more robust health systems and more generally can re-skill the state so that it does not default onto distress outsourcing whenever it wants quick results. Renewal requires much more funding and a new approach, the care-ful practice of policy, which recognises the limits of the control paradigm – the top-down approach to policymaking that has been dominant for three decades.