I have five questions of my own the government needs to answer about coronavirus

We need responses about the invisible NHS managers, on deaths in care homes, on Sage meetings and much more, writes Mary Dejevsky

The UK public is entitled to know, on a daily basis, why the government is acting the way it is (PA)

Rejuvenated by his Covid-19 recovery and his new baby, the prime minister has returned to lend the flagging Downing Street briefings some of his inimitable vim and vigour. Which is all to the good, because the briefings – which have made household names of once invisible eminences such as Sir Patrick Vallance, Professor Chris Whitty, Jonathan Van-Tam and relationship counsellor manque Dr Jenny Harries – were inevitably beginning to flag after five straight weeks.

Nonetheless, they still draw substantial audiences – which is perhaps not surprising, as they offer a fixed point in what would otherwise be just another formless lockdown day. And there was another novelty this week, aside from the return of the prime minister: the inclusion of a question chosen from submissions by – drum roll, please – a member of the general public. When first announced they would take questions, the pollsters making the selection had more than 15,000 to choose from. There is plenty of interest out there, it would seem.

Not to be left out, I would like to submit my own questions, along with the reasons why I think that they deserve both to be asked and to receive an answer. Here are my first five.

1. Where on earth are Sir Simon Stevens, the chief executive of the NHS in England, and the NHS chief operating officer, Amanda Pritchard? So far as I recollect, Stevens’s one and only appearance at the daily briefing was more than a month ago; Pritchard, despite a title suggesting that she might be the top go-to person for supplies of ventilators and PPE, has never appeared. NHS England has mostly been represented by its medical director, Professor Stephen Powis.

So why have the top two executives been so elusive – and indeed all those well-paid managers just below them, in charge of “NHS Procurement” and “NHS Improvement”? As I understood, when these structures were created, the idea was to mark out some distance between the actual functioning of the NHS and the politics. Given that the row raging over PPE would seem to belong squarely in the functional court, where are those in charge of operations?

To give them their due, Stevens and Pritchard have just penned a long letter to all parts of their empire, setting out plans for the “second phase of the NHS response to Covid-19”. But why are they not more visible? Might one explanation lie in pre-pandemic reports of tensions between Stevens and Boris Johnson, who wanted to bring the NHS back, as it were, in-house? Has he been sidelined, pending big changes ahead? That will become clear in due course. But in the meantime, why are top NHS managers not being held to account for what would appear to be catastrophic failings on their highly paid watch?

2. Are there any figures to indicate how many (or what proportion of) coronavirus infections are contracted in a hospital or care home? The question is not just about staff, where the assumption seems to be that they caught it in the line of duty even though that need not be the case. I have in mind primarily patients who had been in hospital, say, for other reasons. That would include some of the small babies who have tested positive.

Why should we know this? First, because although UK hospitals have improved their hygiene in recent years, following the proliferation of MRSA, it remains far from perfect in many places and the fear of contracting the virus is one reason why people have been reluctant to attend even A&E or routine appointments. Second, because if we had an idea of the proportion of people becoming infected inside medical and care establishments, this would affect the calculation of the risk we ran going to the shops, say, or walking outside, or even socialising normally. It could become a reason to relax the lockdown.

3. Is age really as decisive an element in fatalities as the figures collected across the world seem to show? The graphs are indeed striking. But might it not also be the case that older people are more likely to have one or more underlying conditions, especially those such as diabetes or heart or lung problems, which seem to exacerbate the illness? How do the age ratios look if you take out the 95 per cent with other conditions? Given that ethnicity and weight also seem to play a role, would the number of deaths really climb if you “shielded” those in other categories and let the fit over-70s roam free? If we are going to isolate individual groups as the lockdown is relaxed, will we be isolating the right ones?

4. A hospital doctor who recorded his experiences for a BBC news programme was asked what he regarded as the single most effective change in NHS practice that had happened in response to the coronavirus epidemic. Without hesitating for a moment, he said that it was the fact that for the first time in his career, consultants and very senior doctors were now working the same shift patterns as everyone else.

Medics often deny that there is any “weekend” or “bank holiday” effect in increased mortality. On the other hand, any hospital patient or visitor well knows that senior staff can be very thin on the ground out of office hours. A health service has to be a 24-hour, seven-days-a-week operation. To exempt the most accomplished and experienced staff from so-called unsocial hours is not fair on patients and even less fair on the junior staff who must waste time trying to contact the supposedly “on call” consultant, or take life-or-death decisions they are ill-equipped to make themselves. Will NHS managers finally grasp the nettle of consultants’ work patterns when the coronavirus emergency is over? Or will everything slip back to how it was?

5. Are UK governments in general, not just this one, weakened in crises by their susceptibility to “group think” – that is, selecting and only listening to people of like mind and a similar background to themselves? And could the government please always publish the names of its advisers?

As someone who finds herself outside what often seems a very fixed consensus on a whole range of subjects, I am more troubled by the secrecy surrounding the composition of the government’s scientific advisory body, Sage – the security of the members was one reason given! – than I am by the disclosure that the prime minister’s maverick adviser, Dominic Cummings, was in some capacity involved in the discussion.

It is understandable that while a pandemic rages, something akin to a war situation prevails and that any dilution of the official message risks undermining the order to “stay home”, which we must probably accept has been disseminated for our own and for the greater good. That other expert voices should be silenced and other options actively excluded from the public conversation, however, not only violates our right to free speech, but also blocks the exploration of other possibilities.

The UK public is entitled to know why the government followed the example of Italy, France and Spain, to lock us all down, rather than adopting the much gentler course pursued by Sweden and South Korea. I am not talking here about the merits of the “lives” versus “economy” debate, but about trying to find out why the government took the course it did, and whether it considered any of the alternatives.

I have heard it said that the government should reduce the frequency of its briefings. I disagree. If the population is in lockdown, we deserve a daily accounting as to why – even if it becomes tedious over time. Yes, there has been criticism of the so-called “Gotcha!” approach of some journalists, as there has been of some ministers’ evasiveness. But no one should give up now. There are many, many more questions to be asked.