Some of the report's strongest criticism was directed at the then prime minister, Boris Johnson, and the toxic and chaotic culture of his government during its response to the pandemic. Giving evidence, the former head of the civil service Simon Case said good people were just being smashed to pieces, while others claimed there was a sexist culture where junior women being talked over or ignored.
The annual mortality review commissioned by NHS England was originally meant to be published last year but faced repeated delays. It found 39% of deaths of people with learning disabilities and autism were classed as avoidable in 2023, almost twice as high as the general population. NHS England said it was rolling out more training for staff and identifying patients with learning disabilities earlier so they can be given more "appropriate care".