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.

This short report comes from the small deindustrialized town of Blaenau Ffestiniog in North Wales which through the lens of official statistics  would be described as “left behind” But a different kind of close-up knowledge was obtained from a community online questionnaire about the impact of Covid-19  in May and early June 2020. Wages are low and self-employment is precarious but family and community matter to most of our respondents (both native born and immigrants) and most felt that the lock down has brought the community together to help neighbours. At this point, business failure and high unemployment were apprehensions about the future; not the present realities they will be in autumn and winter 2020. But the survey underlines the importance of public policy on access to the foundational basics and the ned to maintain and renew infrastructure which allows families and communities to get on with what matters for them.

Our new working paper Cohesion through housing? argues against regional policy which aims to improve competitivity and create high wage jobs which would “level up” the UK’s “left behind places”. Per capita output measures of GVA and GDP are the standard metrics used in regional comparison. But, household income is more relevant to living standards and our paper focuses on the residual household income measure (after taxes, housing costs, transport and utilities) for owner occupiers, social renters and private renters in all the UK regions. Variation in house prices by region and by cost of housing according to tenure creates winners and losers in terms of living standards. Many ordinary places with low GVA per capita can work well enough for owner occupiers who can set low housing charges against modest wages; just as high GVA London can be purgatory for private renters paying one third or more of disposable income as rent. The implication is that regional policy needs to engage leading as well as laggard regions and to consider how the cost, quality and availability of housing and other foundational services drive living standards directly; and whether housing can be disconnected from the circuits of wealth accumulation.