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In response to the Comment by Jo Goodman and colleagues of the Covid-19 Bereaved Families for Justice,1 we have every sympathy with the individuals for their loss and we too hope that lessons will be learned. However, we believe that they will not achieve their aim by calling for an independent and judge-led statutory public inquiry. Although such inquiries have their place, experience would suggest that they have proven to be particularly poor in their evaluation of operational matters. Such inquiries have core weaknesses, including their desire to allocate blame; their misuse of hindsight and foresight, leading to erroneous deductions; and their failure to explain why a particular approach was taken, given that it is only through understanding the why that we can prevent future failures. Such inquiries also examine events through the lens in which perfection is possible; this false paradigm leads to erroneous recommendations. Furthermore, the recommendations produced are often flawed because they fail to appreciate the gaps between knowing (ie, passive learning) and doing (ie, active learning).

ilures. Such inquiries also examine events through the lens in which perfection is possible; this false paradigm leads to erroneous recommendations. Furthermore, the recommendations produced are often flawed because they fail to appreciate the gaps between knowing (ie, passive learning) and doing (ie, active learning). The irony here is the call for one imperfect system to examine another in the vain hope that one will perfect the other. Despite how they are common practice, there is little evidence that inquiries are an effective way of learning operational lessons from past crises. We must do better. Therefore, we would support an examination of the events from the past year; however, we would also call for an examination of the way in which these inquiries are done to ensure that they produce active rather than just passive learning.