David Cameron has conceded it was a "mistake" for his government to focus too heavily on preparations for combating a wave of influenza rather than a coronavirus-like pandemic.
The Conservative former prime minister told the UK Covid-19 Inquiry on Monday that "many consequences" followed from the focus on pandemic flu rather than other respiratory illnesses.
Mr Cameron defended the programme of austerity cuts to public services under his leadership between 2010 and 2016 that medics and unions have blamed for leaving the NHS in a "parlous state".
In a statement read to the inquiry, his chancellor George Osborne argued that the approach taken following the 2008 financial crisis "had a material and positive effect on the UK's ability to respond to the COVID-19 pandemic".
'Much More Time' Spent on Flu Rather than Other Respiratory Diseases
Giving evidence under oath, he said the time spent focusing on flu during contingency planning was "the thing I keep coming back to" when considering the "horrors of the COVID pandemic".
"I think it was a mistake not to look more at the range of different types of pandemic," Mr Cameron said.
He added: "Much more time was spent on pandemic flu and the dangers of pandemic flu rather than on potential pandemics of other, more respiratory diseases, like COVID turned out to be.
"And, you know, I think this is so important because so many consequences follow from that."
He said he had been "wrestling with" the issue, adding: "But why wasn't more time and more questions asked about what turned out to be the pandemic that we faced?
"It's very hard to answer why that’s the case. And I'm sure this public inquiry is going to spend a lot of time on that."
Mr Cameron was questioned on his own warning back in 2015 that the Ebola outbreak was a "wake-up call" to the emergence of a "more aggressive and more difficult to contain" virus. He said his government did look at pandemics other than flu, such as Mers and Sars.
"So, I think that wasn't a failing; I think the failing was not to ask more questions about asymptomatic transmission, highly infectious … what turned out to be the pandemic we had," he added.
He said that evidence from Chancellor Jeremy Hunt, who was health secretary under Mr Cameron, points to Hong Kong requiring 3 months of personal protective equipment (PPE) for every hospital.
Mr Cameron said he was never asked for funding to meet such a requirement, adding: "Had I been asked, we would've granted it, that's not expensive, that's not a huge commitment."
Planning of School Closures Never Raised
He insisted there was not too little economic planning for a pandemic and said that planning for the closure of schools was never raised during his time in office.
"The furlough scheme came in very quickly, very boldly and made an enormous difference, and that was possible because we had the financial capacity to do it," he said.
Sir Chris Wormald, the most senior civil servant in the Department of Health and Social Care since 2016, admitted there had not been discussion of mass quarantining in planning. The permanent secretary said: "Not in the context of a pandemic."
Mr Cameron insisted that having the "spare capacity to suddenly borrow" a significant portion of national income was "very much in my mind when we drew up the plan to reduce the budget deficit". He denied that cuts led to a depleted health service, arguing it was "absolutely essential to get the British economy and British public finances back to health so you can cope with a future crisis".
Mr Cameron added: "I mean, Greece and Spain had far more austerity, brutal cuts, and yet their life expectancy went up. So I don't think it follows."
Is Austerity to Blame?
The British Medical Association, which represents doctors, has accused Mr Cameron and his ministers of allowing the NHS to get into a "parlous state".
Ahead of the hearing, council chairman Professor Philip Banfield wrote: "I have seen first-hand the damage wrought by years of austerity and a failure to prioritise the nation’s health.
"The UK was severely on the back foot when COVID took hold and this proved disastrous – for the doctors I represent and the millions who suffered at the hands of the virus."
The Trades Union Congress (TUC) has said austerity was a "political choice" that left the UK "hugely exposed to the pandemic".
After Mr Cameron’s evidence, TUC general secretary Paul Nowak accused him of being "in denial about the huge damage caused by his austerity policies".
The inquiry heard a witness statement from Sir Oliver Letwin, who was a Cabinet Office minister from 2010 to 2016 and in charge of resilience under Mr Cameron. Sir Oliver said that "in retrospect" it may "seem surprising" that his reviews did not cover the response to pandemic flu in the UK.
"I now believe, however, that it might have been helpful if I had delved into the pandemic influenza risks myself," he said.
Mr Cameron was being questioned by barrister Kate Blackwell KC rather than the inquiry’s lead counsel, Hugo Keith, who has said he knows the former prime minister. The first phase of the UK COVID-19 Inquiry is examining whether the UK was sufficiently prepared for the pandemic. On Tuesday, Mr Osborne and Sir Oliver will give evidence to the inquiry. Mr Hunt is due on Wednesday, as is Deputy Prime Minister Oliver Dowden.