Understanding the dynamics of policy development and healthcare worker behaviour in the UK during the COVID-19 public health emergency


“Understanding the dynamics of policy development and healthcare worker behaviour in the UK during COVID-19 public health emergency” aims to better understand how UK policymakers have arrived at decisions during the COVID-19 outbreak, and the impact of those decisions on UK healthcare workers. Analysis of policy decisions is usually done retrospectively allowing for rationalisation and leading to bias. This project provides a unique opportunity to observe and analyse the process in real time, with insights of scientific policy advice collected through semi-structured interviews with scientific advisors to the UK Government including members of SAGE and its sub-groups, Public Health England, and other external advisors. This work looks at the decision-making in both the national and Liverpool City response.  The policy decisions made have wide impact on many sectors of society, especially healthcare workers at the frontline of the response. Experiences of UK healthcare workers in response to policies and guidelines for COVID-19 were gathered through semi-structured interviews, to understand the impact to those on the frontline.


Sharing findings in real time

Early findings were reflected upon in an LSE British Politics and Policy blog which highlighted the need for a policy goal to drive policy decisions. Emerging issues were published on the HPRU EZI website as “COVID hot potatoes”, presenting findings in real time with the aim of informing future decisions in the response.  The “hot potatoes” included: the adaptations being made within NHS services to “build back better”; communication challenges of regularly changing guidelines; health system resilience; and the challenge of continuing an “emergency” response without a clear timeline for action.



Early findings from the project during the first wave of the COVID-19 outbreak in the UK allowed for rapid learning and the identification of emerging issues in the response. The perception of what had shaped the UK policies and how these were received by healthcare workers were published in an article titled "Understanding the policy dynamics of COVID-19 in the UK: Early findings from interviews with policy makers and healthcare professionals". The article identifies key themes of early warning systems, clarity of communication, contingency planning, research readiness, delays, scientific advice, central-local tensions and visibility. 


Perspectives on COVID-19 testing policies and practices from both scientific adviser and healthcare worker interviews were published in June 2021. This article highlighted: tensions between the pace and scale of national testing developments and their communication and implementation; differences in perception between scientific advisors and HCWs about testing, infectiousness and risk; and uncertainties about the organisation and implications of testing at the local level


Impact through UK Parliament

Written evidence informed by the work of this project has been submitted to Parliamentary Select Committee inquiries into the COVID-19 response, contributing to the scrutiny of the Government response by the cross party groups. The first submission was made to the House of Commons Public Accounts Committee Inquiry “Readying the NHS and Social care for the COVID-19 Peak” and presented healthcare workers’ perceptions of preparations for a second peak, staff resilience, continued impact of equipment shortages, and the impact on non-COVID-19 services. Second, a submission to the House of Commons Science and Technology Committee Inquiry “UK Science, Research and Technology Capabilty and Influence in Global Disease Outbreaks presented the perceptions of scientific advisors in relation to the use of scientific advice in the response. Finally, a submission was made to the House of Lords Public Services Committee inquiry “Lessons from Coronavirus” which focused on the relationship between local and national services in relation to the centralised response.


Data collection and analysis is now complete. Further publications, policy briefs and dissemination materials in preparation. Future work will be highlighted here.