UK Inquiry Module 1: Resilience and preparedness

[elbows]

There isnt a huge amount for me to quote from Whitty and Vallances evidence, so I will probably do that another day.

Oops, there is actually a lot I want to quote, especially from Whitty. I'm having trouble chopping it down to keep it brief.

I'm afraid I wont be referring to transcript page numbers this time. And the quotes will be spread over quite a few posts. They are all from Thursdays transcript https://covid19.public-inquiry.uk/w...25/C-19-Inquiry-22-June-23-Module-1-Day-8.pdf

Whitty:

I think Dame Sally has raised the issue of, were we imaginative enough, were we radical enough in our thinking, for example, about prevention, I think it is quite difficult to be radical when you've got a very diffuse system, it's much easier to do that, actually, when you've got the whole system operating together. So the SAGE mechanism allowed for much faster decision-making and much more focused and, in my view, more radical thinking than occurred between emergencies.

You know, I think central to a lot of the debate that you've had over the last several weeks, and in the excellent written statements to the Inquiry, has been the point that we should have had a more imaginative approach to how we would respond to a major pandemic, whether it was influenza, something like influenza, or indeed something else. But this would require quite radical changes in the way people think. Now, I don't think the current committee system, which is excellent, is designed to inject radicalism of that size into the situation. It's very good at responding, it's very good at horizon scanning, in my view, relative to what is realistic. So I think that is potentially the big weakness in the system: how do you inject radicalism into the system, rather than how do you respond to expertise.

The question about should we move beyond the individual components of what were termed, in Covid, NPIs, non-pharmaceutical interventions, rather a clumsy term, essentially meaning social measures, many of which are long-standing, quarantine, individual isolation, closing schools, many of these go back to the Middle Ages or beyond, these are not new ideas. However, the very big new idea was the idea of a lockdown. This is often -- all the NPIs are sometimes called lockdown by some commentators, but I'm talking here very, very specifically about the state saying people have to go home and stay at home except under very limited circumstances.
Q: A very radical thing to do. Mandatory quarantine?
A: Mandatory. Really big thing. I would have thought it would be very surprising, without this being requested by a senior politician, or similar, that a scientific committee would venture, in between emergencies, into that kind of extraordinarily major social intervention, with huge economic and social ramifications. So that's my point, is that it is very difficult for the committees to go beyond a certain level unless they are asked to do so externally.

 

[elbows]

Whitty:

However, there is undoubtedly a lot of benefit from getting external challenge. So the challenge doesn't all have to be within the committee. I think there would be strong arguments for having mechanisms for actually essentially putting an antithesis to the thesis that's put forward by a body like SAGE. People talk about red teams, whatever, there are lots of ways of describing it, but the principles, I think, are perfectly reasonable, actually. But I think that may be a more efficient way to do it than to try and have every single aspect of every opinion represented in the one committee. I think that would be tricky.

Q: Is that, to take it from another angle, because some or all of you are, as described I think by your colleague Sir Patrick Vallance, licensed dissidents? It is in the nature of being an expert, and of being particularly a scientific expert, that there is a tendency to challenge orthodoxy, it's part of the nature of the job you perform?

A: I think that some scientists overemphasise their own unorthodoxy. There is a scientific orthodoxy at any point, and in fact the job of SAGE, and I think this is something which I'm sure will be very central to our discussions in the next module, is not, in my view, to provide radical ideas, it is to say this is the central position of science in the world at this moment in time, accepting the science may move on. So it's not actually designed to be a radical body as such, it's designed to be an expert body. Those two are not necessarily contradictory, but they -- certainly the aim of it is to provide a central view.

Yes, so the second part is you asked very specifically on economics, and I think this is a very important question. The problem you've got is that the people around SAGE tables are not best placed to provide challenge to one another or to an economist coming in. If you had two economists on SAGE, you would not be in a situation where SAGE would suddenly become an economically extraordinarily competent body. It would be a competent scientific body with two economists on it. Which does not strike me as actually answering any terrible useful question.

 

[elbows]

Whitty:

So I thought the report on Exercise Alice and the exercise itself actually were very good and very useful. I don't think -- and I also think that it was sensible to do all of the recommendations that were put into it. So I thought they were all sensible. But actually they were incremental re-statements of existing thought. In fact, they weren't a new approach, they were essentially a bringing together and saying we've got to be more systematic about something we were already thinking about, aiming at the kinds of things that were seen with MERS and SARS, which were relatively modest size scale outbreaks compared to Covid, but still very significant infectious outbreaks. So Operation Alice was aimed at that problem, it wasn't aimed at a pandemic problem. I think the other very good report that goes alongside it is Dame Deirdre Hine's report after the pan flu -- sorry, the H1N1 2009 flu pandemic. That also has a number of very sensible recommendations. Both of those I think would have helped us, but I don't think either of those would have led to the completely different approach to a pandemic which developed during the first few weeks of Covid.

Q: To what extent was it recognised generally, either in the Office of the Chief Medical Officer, although that was before your time, so perhaps in the Office of the Government Chief Scientific Adviser, and the DHSC or the Cabinet Office, that there was a need to refresh the strategy, that it was a single strategy dealing with pandemic influenza and it was by then self-evidently a little out of date, and there was no other strategy for non-influenza pandemic in existence?
A: So I'm going to just go into one bit of Sir Humphrey-like language differential. In government, "refresh" generally means update but it doesn't mean any major shift. When you read this document now, with the benefit of having been through the thought processes that unfortunately we've had to be faced with during Covid, it clearly needs a complete re-think. It doesn't need just a refresh. Had there been a refresh, to use that term, which is not one I particularly like but I'm just using the term that was used, it would not, in my view, have significantly changed of its philosophical approach. It might have updated some bits around legislation and bodies and so on, but it would not, I think, have been materially different to what it is now, and I think what it needs is a re-think and I also think alongside it, and I've discussed this with colleagues already, I've said we need to do this, there needs to be a separate equivalent thing for non-influenza pandemic, so I think essentially there need to be two documents.

I think I would differentiate here between having documents and having thinking. If you think about NERVTAG, which you've already talked about, NERVTAG was explicitly designed to cover non-influenza risks. Certainly my own thinking is not in any way limited to influenza. I think I submitted as evidence a talk I gave in Gresham College in 2018 just to prove it was not a post hoc rationalisation, there have been a number of those, and to make the point that most of what I was talking about was not influenza. So I don't think it would be correct to say that no one was thinking about anything other than influenza. There were only documents about influenza. That's slightly different. And in reality, when I looked at this document at the beginning of the Covid pandemic, I did not feel the document gave me much that was of any great use. So the document and the thinking are, in reality, separate things.

 

[elbows]

Whitty:

because every pandemic is very different and sometimes massively different from its predecessors, having plans and documents of this sort is actually not generally the most useful way to deal with it. What you need to have is capabilities and flexible capabilities which are backed up by resource sufficient to be able to scale them up. I think in a sense the danger in government is that people feel the document is written and therefore the problem is solved. I absolutely do not think that's the case. I think it's to do with: do you have a range of capabilities properly resourced with people who know how to operate them and have the mandate to do so?

What we didn't then do is go down to say: okay, well, what are the building blocks you're going to need for different sorts of pandemic, with different variable levels of both route of transmission and mortality in particular? If I can illustrate that, and I am going to use lockdown, because I think it is so central to the thinking of lots of people who are thinking about this Inquiry, if you look back over the last several pandemics you certainly wouldn't have used it in H1N1 in 2009, because it was not a large enough impact on society in any way to justify it --
Q: Well, you have just made plain, because it was a mild influenza pandemic?
A:Correct. Then, going back to the next one, HIV, a very serious thing, you would never have used it, because it would have not worked at all. That whole route of transmission was different. It wouldn't have worked against plague, it wouldn't have worked against cholera. It might have worked against the H1N1 1918 pandemic possibly, and that might have therefore been justified. But I'm just making the point that actually you have to be extremely adaptable to the problem you deal with, but you also have to say, well, if you go to the top range of mortality, how can we actually get that down and is society prepared to pay the price to get that down. I think that was, in a sense, the leap of imagination, not just the UK but just internationally I think we had not fully made, because the UK position was identical to almost all of our neighbours, to the WHO and so on, it wasn't a uniquely UK position.

I'd certainly agree that we did not give sufficient thought to what we could do to stop in its tracks a pandemic on the scale of Covid or indeed any other pathogen that could realistically go there. I do think, on the other hand, it is sensible to have a plan for if everything fails what are we going to do.
We do still need to be able to say, "Let's go to the top of the range, actually we could end up with 750,000 people dying, where are we going to bury bodies? Where are we going to ..." These are important -- they may seem morbid but they are practically important planning things, and in this sense I do think a plan is important. But where I would completely agree is that we do need to actually start off, and I think this was brought out in Mr Hunt's evidence yesterday, and also Mr Letwin's, all of them essentially said: we saw this huge problem and we didn't say to the system, "Well, how are we going to stop it?"

 

[elbows]

Whitty:

However, some of the very specific learnings that people raise are, in my view, technically incorrect. I don't want to go through them in great detail, but for example, you know, I've spoken to my colleagues in South Korea about MERS. Their principal problem was an issue of hospital transmission, that's where most of the transmission -- well, the large part of the transmission -- force of transmission came from. What that did though is it made them think they had simply under-invested in, both intellectually and financially, public health, and they did so. They completely changed the way -- they were much more systematic. The same was true in Canada, for example, after SARS: exactly the same issue, a lot of the transmission was in hospitals, the numbers were small but the impact was very substantial, they changed what they did and they re-thought their whole approach and they reinvested in public health. That is a very, very generic learning. It wasn't the "This is a coronavirus and therefore we can learn from a coronavirus". I think -- for a variety of reasons I don't think it's -- probably this is the right place to go into, it's a very, very long chain of logic but it is -- I'm reasonably solid about it -- I think that it was much more the generic "We need to strengthen public health responses to infections and take them very seriously at the earliest possible stage and scale", rather than "These particular learnings we took away from this particular virus".
Q: So the generic, the systemic improvements rather than specific countermeasures, for example?
A: Yes, there are some exceptions, but broadly that is my view.

Then we need to have the ability to scale up in the predictable areas, which would include things I've mentioned already, like diagnostic skills, it might include PPE, protective equipment, and a variety of other areas. It's this scaling up which, in my view, was the weakness that was demonstrated during the early phase in Covid, and I laid out a kind of five-stage -- in the witness statement, I'm not going to go through it in full, a five-stage process, but the first three stages were an initial technical response to the small number of early cases, which I think was done well and I think the UK is well set up for, then a scale-up phase, and then the point where the full capacity of the state is in play, which is a political decision essentially.

But that scale-up between them needs to be possible and that requires investment. Now, how much investment is a political question, but I think what we need to do is put to political leaders, who absolutely have to make this decision: what is the level of risk that you think we should be insuring for? And this should be explicit.
I think we've not necessarily always done that, and said to our political leaders, who speak for society and must have the last word: this much additional risk mitigation, held in some form of another, will reduce the risk of a future pandemic or other emergency, but it will cost this much and do you essentially wish to take that insurance? That I think we have not done and I think we need to be a lot more explicit about this.

Q:In effect, the choice for future politicians or current or future politicians for society and the public must be plainly identified so that that choice is available to be exercised?
A: Exactly. It may be exercised through holding dual use facilities, maybe by holding contracts with private sector, a variety of ways it could be done, but it will
have some implications and that resource will have to come from somewhere else.
Q: Of course.
A: So there will be a choice for people between having an insurance against future events and, for example, investing in immediate emergencies, pressures in the NHS during winter and so on. That is a choice and I think it has to be made explicit.

 

[elbows]

The last of the Whitty quotes I have picked:

Q: One, firstly, why is data and the provision of data so important to preparedness?
A: If you think about the decisions that were being taken both early in the pandemic and subsequently, all of them rested on having fast and reliable data, and if you don't have that data and you don't have it from around the country with a representative group of the population, you're essentially driving in the dark, it's very, very difficult to work out what the right decisions are. As I'm sure we will come on to in the next module, this caused us some significant problems in the first part of the response.
It also -- the more data you have, the more exact your decisions can be, the nearer, in a sense, to what's the optimal outcome, because you're always trading off different very significant risks between things, political leaders need to be given data, and you can also on that base research studies on which you can then devise the countermeasures, the medical countermeasures which will be the way out of the pandemic in the end.
One of the key themes of the technical report and, indeed, a lot of what I've said elsewhere is that you move from societal interventions, which are by definition crude and damaging, but they're all you have initially, because you don't have drugs, you don't have vaccines, you don't have diagnostics, and so on, you move over to a medical intervention, but that depends on research, and research depends on data. So they are linked together.

I would absolutely not want to venture to suggest any particular training for our political leaders. I think much of what they bring is the ability to ask questions, which, in a sense, people bring because they're new to a field. I think one of the dangers in all areas of expertise is you become snow-blind, you don't realise the obvious question, and actually having political leaders who come in from outside is one of the ways in which they can produce radicalism.

I think, however, what is helpful is for people to realise the range of capabilities they have at their disposal, and therefore whilst I -- you know, whilst that's entirely optional for certainly political leaders, that's their choice, I do think within government there's sometimes a lack of understanding of science between emergencies.This goes back to this between emergencies and in an emergency. In an emergency everybody is clamouring for science advice. I've seen this in every emergency I’ve ever seen. They are desperate to get the scientists in the room. Between emergencies you have to kind of elbow your way in. So it's the ability to actually engage all the way through the system between emergencies, that I think is the big risk. People can pick things up very quickly when they need to. A very large proportion of the British population now know a lot more epidemiology than many doctors probably did three years ago. So, you know, people can pick stuff up very quickly when they need to. What I think they need to do is think about the range of issues between emergencies which may, in due course, lead us into problems.

 

[elbows]

I have a few chunky Vallance quotes that I will deal with another time.

This mornings evidence from Emma Reed of the DHSC emergency preparedness directorate was similar to other tedious evidence from the world of officialdom. Crap priorities, big gaps, general failings. As such i'll probably only bother to quote one or two examples once the transcript is available.

The evidence from today second witness, Rosemary Gallagher an infection prevention specialist from the Royal College of Nursing is more interesting and I will be sure to quote some of that later on.

Its Jenny Harries later, I'm not looking forward to that.

 

[elbows]

Much of todays evidence involves the structures and bureaucracy that I do not intend to cover fully during these public evidence sessions. But there is still plenty else to quote from.

A bunch of Emma Reed (Director of Emergency Preparedness and Health Protection at DHSC) roasting examples as promised.

From todays transcript at https://covid19.public-inquiry.uk/w...02/C-19-Inquiry-26-June-23-Module-1-Day-9.pdf

Pages 10-11:

Q: Do you recall when you took up post anybody briefing you about the serious concerns expressed by the Department of Health and Social Care's own departmental board about whether or not there were systems in place to track or quarantine thousands of people in the event of even a moderate pandemic?
A: There was no discussion with me about quarantining.
Q: What about track and trace, any discussion about that?
A: There was no discussion with me about track and trace.
Q: All right. Then, in relation to paragraph 26, did anybody at your very senior level in the department say, "Ms Reed, we've got concerns about how fragmented the system for preparedness in the United Kingdom has become, this is something that your directorate is going to have to grapple with"?
A: In the terms in which you set out, no. But the process for how the system would respond to a pandemic -- and by the system I mean organisations in health and social care -- was both a factor of our pandemic flu readiness programme but also one of the learnings from Exercise Cygnus, so the intent of that paragraph and the issue relating to system overload was something that I was aware of, yes.

Page 14:

Q: In the event of a national crisis, in the event of, as it turns out, a catastrophic health emergency, the Department of Health and Social Care is the lead government department which drives forward what is required to be done to prepare for and, initially at any rate, respond to that crisis?
A: That's correct.
Q: So what other strategies for dealing with a pandemic-scale catastrophe were there than this single document?
A: The Department of Health owned the single document for the strategy for pandemic influenza preparedness.
Q: Right. It was the only strategy document, was it not?
A: Yes.
Q: There was no strategy document for anything other than an influenza pandemic?
A: That's correct.

Page 17:

Q: The 2011 strategy assumed -- and we can see at paragraph 7.5 -- that "staff absence is likely to be significantly higher than normal across all sectors", levels of absence may vary due to the size, and then if you could scroll back out, please, and in the middle of the page, 7.4: "... the Government will encourage those who are well to carry on with their normal daily lives ... The UK Government does not plan to close borders, stop mass gatherings or impose controls on public transport during any pandemic."
Any pandemic.
Between 2011, when this strategy was first made, Ms Reed, and 2020, when the non-influenza pandemic struck, are you aware in the Department of Health and Social Care of any person at any time questioning that statement, "the UK Government does not plan to close borders, stop mass gatherings or impose controls"? Was there any debate about the possible necessity of border closings, self-isolation, quarantine, mass quarantine, mandatory quarantine, or anything of that sort?
A: I'm not aware of any conversations on those areas of mitigation, no.

Pages 22-23:

Q: In the risk assessment process, and the procedure was updated, as you know, in 2016 and then 2019, what was the assumed outcome of a severe influenza pandemic on the United Kingdom in terms of fatalities?
A: If I recall, I believe the number to be about 8 -- 800,000, I think, but I'm recalling, I might have that number incorrect.
Q: Around 800,000 deaths?
A: (Witness nods)
Q: Of which, if the pandemic were to be particularly dangerous to the elderly, a significant proportion of those deaths would be in the care home sector, would they not?
A: I would believe so, yes.
Q" Yes. So let me put the question again: in terms of the balance between the possible outcomes of an unprepared no-deal EU exit and the appalling loss of life attendant upon a pandemic for which no preparedness had been carried out, why did no one say "We cannot afford to stop the pandemic preparedness"?
A: I think in response to your question, there's a couple of points I think are important to make.
The first one is that the adult social care sector had done some work in pandemic preparedness prior to the pausate of the work.
Secondly, I think the work that was done for Operation Yellowhammer was of benefit to our preparedness for a pandemic influenza.
Then the third point I'd make is that, in considering where to allocate resources, what I consider is: what is a real and present and credible threat versus the risk of a threat? And to try to strike the balance of where resources are allocated, I retained teamwork on pandemic preparedness, but I also allocated resources to deal with the real risk of a disruption through a no-deal exit.

 

[elbows]

On and on it goes like that. Here are a few more:

Pages 46-47:

Q: Page 8, at 3, work to be done on how the public would respond to a pandemic, that is to say whether it would self-isolate, whether it would cope with the demands of mandatory quarantining, how it would respond to social restrictions; correct?
A: I can't say with certainty whether any of the work was done on this particular recommendation. I don't think it is concluded.
Q: Now, the only thing that was done, Ms Reed, wasn't it, was that a committee was set up called MEAG, of which my Lady has heard, the Moral and Ethical Advisory Group, which would give advice in the event of a pandemic on some of the moral and ethical questions that might arise?
A: Yes.
Q: But the work done, the behavioural work done as to how the public would deal with social restrictions and non-pharmaceutical interventions and how in practice the country would be enabled to deal with the consequences of a catastrophic pandemic were not addressed at all, were they?
A: No.

Pages 56-57:

Q: You've already explained and other witnesses have explained that that was because of the necessary preparations for a no-deal exit, Operation Yellowhammer interfered in this process. But why did the fact that the particular workstreams were in some places being paused or not completed mean that the board itself didn't have to meet between November 2018 and November 2019? Why was Operation Yellowhammer a sufficient explanation for why the board didn't meet as opposed to why some of its workstreams were not being seen through to their conclusion?
A: I would say that the reason for that is that our prioritisation of resources in working on pandemic flu were prioritised at the delivery of key elements of the programme rather than in the secretariating of a board.
So I prioritised our work on the Bill and on work to do with excess deaths and MEAG rather than board secretariating functions. So the work continued but we didn't run a board.
Q: You were the prime civil servant, along with Ms Hammond, on that board?
A: Yes.
Q: You effectively co-chaired it?
A: Yes.

Q: You knew the board was not sitting and did not sit for a whole year.
A: That's correct.
Q: Did you not think to yourself, "The risk of a pandemic has never gone away, these are important workstreams which the Prime Minister ordered to be done, they are things that matter, they reflect the conclusions of Exercise Cygnus, they are important aspects of getting this country ready for the Tier 1 risk, the greatest risk in the entire risk assessment process, I think we should be sitting"?
A: I -- no, I don't. I think that what I took as a judgment was, firstly, that resources were needed to support the response to the real threat of disruption from a no-deal exit and, secondly, that I prioritised work that needed to be completed on capabilities that actually were used in the Covid situation, which included the Pandemic Flu Bill. Those pieces of work could continue outwith a board structure.

Pages 61-63:

Q: Ms Reed, other than the obvious point that some people 24 may be more clinically vulnerable to a pandemic, the only consideration in this whole ten-year period given to the position given to members of ethnic minority groups or vulnerable sectors of society, by way of your pandemic planning, was making sure that health information would be available in a range of languages; is that the sum of it?
A: I don't believe that to be true, we considered equality impact assessment as part of the -- as the 2011 strategy, we considered an impact assessment as part of the pandemic Bill preparedness that you mentioned earlier. In guidance that went to local resilience forums they talked about people who would struggle to access mainstream healthcare, which included those who were homeless and disenfranchised. So there was work to do that. It wasn't systemic -- systematic, I apologise, but there was work to consider vulnerable people.
Q: The work that was done, and you've just referred to it, was a consideration -- there was a paper called the Equality Duty paper, which came out around about the same time as the 2011 strategy, there was nothing thereafter, which considered the legal obligation imposed on the government generally under the Equality Act 2010, known as The public sector Equality Duty. Is that the duty to which you're referring?
A: Yes.

Q: Right. That was a broad omnibus consideration of the power or the duties of the government under the Equality Act. Where was a single paper referring to what the impact would be on the particular parts of society to which I've made reference of either a pandemic or your planning?
A: There was no single piece of paper with that on it.
Q: Right. Do you accept from me, evidence through me, evidence from the government's own Equality Hub, and its director, Mr Bell, who has given a witness statement to
my Lady, which says: "Reasonable and proportionate searches have been conducted ... I can confirm that this department was involved in no work related to the United ... government's response to civil emergencies, including a pandemic. There was no contribution to the design or preparation of any policy response on behalf of the United Kingdom government in the event of a pandemic."
Just no work was done on this topic at all, was it?
A: There was no overarching assessment of the impact of the pandemic preparedness strategy on inequalities since the publication of the strategy in 2011.
Q: Thank you.
A: Had there been a revision, we would have done that.

 

[elbows]

And now some evidence from Rosemary Gallagher MBE (Professional Lead Infection Prevention and Control at Royal College of Nursing), where thankfully the answers are more interesting than the questions, unlike the previous witness.

Pages 71-72:

Q: In his evidence to this Inquiry, Jeremy Hunt has said that in his view there was a groupthink that the United Kingdom knew that this stuff, as he described it, the best, and that we had no need to look further afield to other countries in order to try and learn from their experience. In particular, he said: "... I don't think people were really registering particularly Korea as a place that we could learn from."
Did you observe this type of groupthink as described?
A: I did.
Q: Yes, and did you raise your concerns in relation to that with anybody or any organisation?
A: In response to the work that we did with Saudi Arabia, and also in relation to the work we did on Ebola, we raised significant concerns around the different needs, for example, for personal protective equipment that may differ from influenza. So the concerns that we raised came out of our experience supporting other incidents and were fed directly back to those involved.

Then on pages 79-80:

Q: Right, and you tell us at paragraph 36 in your witness statement that you believe, in your extensive experience of that outbreak:
"... significant lessons should have been learnt from the experience with MERS CoV. For example, the Gulf Co-operation Council's IPC guidance specifically addressed the airborne spread of MERS CoV and the requirement for the use of RPE."
A: Yes, that's correct.

Q: You go on to say in a following paragraph:
"The Covid-19 pandemic has shown that there was too much of a focus on preparing for a flu pandemic and not enough consideration was given to how such plans would need to be adapted to deal with a respiratory infection pandemic, where the primary mode of transmission was not necessarily via 'traditional' droplet transmission."
And:
"... that airborne transmission needed to be properly factored into IPC Guidance concerning the level of PPE required for health and care workers exposed to patients with Covid-19."
A: That's correct. We had the experience of MERS CoV in Saudi Arabia and we additionally had the South Korean experience as well, both of which showed that transmission within healthcare facilities was entirely possible in addition to community spread of infection.

 

[elbows]

Continuing the Rosemary Gallagher stuff, pages 82-83:

Q: You say: "There was ... a palpable change in culture, in the years immediately preceding the Covid-19 pandemic, brought about by the successive administrations. This seemed to manifest in an attitude where engagement with stakeholder organisations seemed to be less of a priority."
Can you expand upon that, please. What did you mean by a "palpable change in culture"?
A: So as I've described, our experience supporting the incidents of MERS and Ebola were very positive experiences in terms of the engagement and the value that professional nursing was held in, so far as we could support that. At the time, around 2017, we were also part of an antimicrobial resistance programme board that was managed by Public Health England, that, again, had a variety of stakeholders, including the RCGP, the Royal Pharmaceutical Society, around the table. Once that was disestablished, about a year later, stakeholder engagement was significantly reduced and really remained that way until the pre-pandemic period.
Q: All right. Just taking that into account and moving back for a moment to Exercise Cygnus, do you believe it was a mistake for the Royal College of Nursing not to be involved in that exercise?
Yes, but I would go further and say it was a mistake not to involve other professional organisations alongside ourselves as well.

An interesting quote from a different witnesses statement came up in one of the questions that I wont go into further depth about right now:

Pages 83-84:

Q: May we put up, please, a paragraph of the report that's been provided to the Inquiry by Dr Claas Kirchelle. Thank you. It's at INQ000205178, and we're looking at paragraph 112. I want to seek your opinion on this paragraph, please, Mrs Gallagher:
"There were also ongoing concerns about [Public Health England's] ability to act as an independent advocate for public health from within the Department of Health (from 2018 Department of Health and Social Care ...). In 2014, the British Medical Association ... warned that 'the requirement to adhere to civil service rules and regulations is having an impact on [PHE staff's] ability to do their work. Particular concerns have been raised about ( ... ) the ability to publicly discuss or criticise public health policies'. In surveys, local authorities noted that PHE could do more to 'acknowledge the pressures and constraints facing Local Authorities in its work with them' and 'be more vocal around issues such as welfare reform and austerity and what this means for the health of our nation'. A later witness seminar also highlighted that the increasingly rapid turnaround of civil servants across government departments had created a lack of specialist interlocutors and understanding in Whitehall."

Likewise a quote from Hunts written evidence also came up, in the context of staffing issues. Pages 90-91:

I'd like to display, please, the witness statement of Jeremy Hunt, please, just to underline this point, page 15, paragraph 66. Could we highlight this, please.
"As I have written elsewhere, one of the things I learned in my time as Health Secretary and wish I had understood better at the outset was the importance of workforce planning. This was not something I implemented while Secretary of State because it took me some time to appreciate the full picture. I was also not advised to place more emphasis on this because the NHS had a longstanding habit of relying on immigration to fill any gaps. However, with a two million shortage of doctors globally according to the World Health Organisation, this was not a sustainable position in the long term."
Now, the former Secretary of State for Health and Social Care doesn't mention nursing there --
A: No.
Q: -- he uses the shortage of doctors as an example, but would you say, Mrs Gallagher, that the issue was just as important in relation to nursing and workforce planning?
A: Absolutely. We know we have a global shortage of nurses, as identified in the triple impact report, so this is a global problem, and the reliance on overseas nurses is a real cause of concern for the Royal College of Nursing.

 

[elbows]

Final stuff from that witness.

Pages 94-95:

Q: Professor Philip Banfield from the British Medical Association has provided a witness statement to the Inquiry in which he says that reforms to the public health system in England in particular led to a fragmented system and that the 2012 Health and Social Care Act fractured in many places the links between public health specialists and NHS colleagues, which in turn impacted upon pandemic response.
Do you agree with that?
A: I do.

Q: What role does community infection prevention and control have to play in pandemic planning and emergency response?
A: So the role of community infection control teams has changed over time. When I was in clinical practice we provided support from the acute trust to our community partners and provided them with an infection control service, but in other areas they have dedicated infection control teams. So there is variation across the system on how advice is provided.
We know that when the Lansley reforms, the changes to the NHS -- the Health and Social Care Act was implemented, that we lost many community infection control teams as staff moved under the umbrella of local authorities away from their original employers, and that gap, if you like, placed increased pressure on health protection teams, but also had an effect on local relationships and resilience locally.

Pages 107-109:

Q: You say that without a sufficient stockpile of that equipment, not only for hospital settings but also for community nursing, nursing staff are putting their own lives and the lives of their families and patients at risk.
But in addition to the availability of such PPE, is it also necessary for those who are going to be utilising it to know how to fit it properly?
A:Yes.
That involves staff training in fit testing.
Q: From an RCN perspective, is there or indeed was there at the onset of the pandemic sufficient capability within staff who might need that PPE to be able to fit it properly? Had the training been in force and in place?
A: If I might go back a little step --
Q: Certainly.
A: -- briefly. The failure to consider a pathogen that had pandemic potential that would require the extended use of respiratory protective equipment was not duly considered, and it is my view that that had an effect on how large the stockpile was of respiratory protective equipment as opposed to face masks.
If you take that to the next degree, then I would have expected consideration of the need to cascade fit testing to be in place as part of pandemic preparedness.
When a pandemic or an incident first starts, it's absolutely critical that we also take a precautionary approach to what it is we are dealing with until the science tells us otherwise, and that would also have implications for how much respiratory protective equipment we would need. It's clear now that those systems for escalating fit testing, and also the system for having standardised respiratory protective equipment, was not in place, and by that I mean the demand for respiratory protective equipment resulted in many different types of masks being available, and masks fit people differently. So whilst your face may fit one type of mask, it may not fit the other. So this then necessitated multiple attempts or multiple -- the multiple -- multiple requirements to fit test staff on numerous occasions because of the numerous types of masks that were required.
So I don't believe that the system was well set up to consider this as part of pandemic planning.

Pages 110-111

Q: Frontline workforce and planning for minority ethnic members of the workforce. Paragraph 63 of your report, you say that:
"In its written submission to the ... Treasury Comprehensive Spending Review ... [in] (September 2020) ... the [Royal College of Nursing] highlighted the overrepresentation of BAME staff at bands four to six, which represent those professionals providing care on the frontline, warning that they may be at increased risk of exposure to the viral load of Covid-19."
And you also highlighted the fact that:
"... as the pay bands increase, data shows larger increases in the number of white staff at each pay grade compared to the increase of in ethnic minority staff."
Was the risk of a disproportionate impact on minority ethnic staff mitigated against within pandemic planning as far as the Royal College of Nursing is concerned?
A: In my opinion, no, but as I've stated before, we weren't involved in pandemic planning.
Q: But you haven't seen anything or had anything brought to your attention in your position to indicate that it was so considered?
A: Not that I recall. The language used in most strategic documents tends to refer to at-risk groups --
Q: Yes.
A: -- or, as you've said, other clinical vulnerabilities linked to medical conditions, but not inequalities as described by Professor Marmot, for example.

Pages 112-113:

Q: Finally, is there any recommendation that you would like to bring to the attention of the Inquiry so far as transparency is concerned?
A: Transparency is absolutely vital to support communication. In my experience, I have found that healthcare professionals and the general public are very understanding that guidance and advice changes as an incident or a pandemic evolves, and they are very forgiving of changes in guidance and advice. But they need to understand why. So we are able to bring people with us if we can do that, and bringing in the public and our healthcare workers with us at a time of national crisis is absolutely vital.
Q: So transparency and information provision?
A: Yes.

 

[elbows]

I havent decided how much of Jenny Harries evidence to quote yet. She didnt wriggle hideously on certain topics like some of the politicians and non-medical/scientific civil servants did, she didnt mind admitting when fragmentation and lack of funding had caused problems, although also injected positivity where it was possible to do so. She didnt come out with anything as groanworthy as her most infamous comments during the pandemic. But some of the subjects were to do with structures, history of organisational changes and operations matters that, whilst still important, are not really my focus for dissection at this time.

And Hancock is a witness tomorrow. So I will probably have to come back to Harries and Vallance a little later.

 

[elbows]

Todays evidence from Hancock is receiving plenty of media attention, as we'd expect.

Much of what he said is going over all the failings that we've already heard much about, and that the media will report on in a way that means there is no need for me to quote these things at length.

What I will focus on is his central point, which he also uses as a shield to reduce the scale of the consequences of these other failures. I will not defend his use of this stuff to reduce criticism of his failings and inactions. But his central point is still extremely valid and it gets right to the heart of some of my primary concerns.

I have been concerned that the inquiry wouldnt reach all of the correct conclusions if it ended up going too exclusively down the path of accepting that the main underlying cause of planning faults were just down to (a) details of asymptomatic vs symptomatic transmission and assumptions made on these fronts, and (b) planning only for a flu pandemic instead of other sorts of pandemics. Because while there is important stuff to be found within those themes, they could be used to distract from an idea that I hold dear: that our plans would also have been shit if faced with a severe flu pandemic, and that there was a total lack of focus on actually trying to reduce the spread of the virus in the first place.

Some other witnesses have touched on those themes to my satisfaction, but I was very pleased that Hancock made the point far more forcefully and bluntly. And so much of what I quote from him later when the transcript is availabe will be on this theme.

 

[Thesaint]

that our plans would also have been shit if faced with a severe flu pandemic

I also find this 'it's not flu' explaination puzzling, if only because whether it's flu or corona family, broadly speaking the symptoms are similar, go after the same victims, and transmit the same way in the end.
A higher R rate makes it spread faster I know so changes to a spike rather than a hump, but ultimately is the same underlying problem.

 

[elbows]

I also find this 'it's not flu' explaination puzzling, if only because whether it's flu or corona family, broadly speaking the symptoms are similar, go after the same victims, and transmit the same way in the end.
A higher R rate makes it spread faster I know so changes to a spike rather than a hump, but ultimately is the same underlying problem.

Its down to a bunch of reasons all mashed together, such as:

The fact they got away with a bunch of 20th century flu pandemics without having to lockdown or anything close to lockdown.

The fact they have some antiviral medications and vaccine pathways for flu, so can assume they have a few options that will resemble being seen to be doing something and offering people some kind of protection even if they dont bother trying to halt the spread of the virus.

The fact they can use certain characteristics and assumptions about flu as an excuse not to bother with certain measures. For example the shorter incubation period of flu compared to covid has been hovering round this inquiry as an excuse for never considering lockdowns - they havent gone in depth on this topic but the shadow of this premise is there at times. Its an excuse that inhabits the same sort of territory as the whole symptomatic vs asymptomatic transmission thing.

So these sorts of things combined with a few other things tend to combine and end up making flu pandemics synonymous with the orthodox approach, an approach that was found wanting in the covid pandemic. The key is to unpick this stuff whenever lazy thinking and convenient excuses are constructed using any of the above assumptions or any others, to throw out the orthodox flu baggage and associated lack of ambition in pandemic planning. The enquiry has been given enough evidence to do so, but hasnt managed to demonstrate to my complete satisfaction that they will completely escape the gravity of these old ideas. For example the ledad counsel is still occasionally asking questions where the idea that flu is symptomatic is baked into the question, and when faced with such questions many witnesses arent explicitly pointing that out every time.

 

[elbows]

Its not actually going to be that easy to quote from the transcript in a way that adds a substantial amount to this sort of press report, but Im going to try shortly anyway. There is probably the occasional useful sentence that they have left out. There will inevitably be plenty of overlap between what I quote and whats already been quoted in the media.

Matt Hancock says UK's pandemic strategy was completely wrong

Planning focused more on burying the dead than averting disaster, ex-health secretary says.

www.bbc.co.uk

 

[elbows]

Todays transcript: https://covid19.public-inquiry.uk/w...1/C-19-Inquiry-27-June-23-Module-1-Day-10.pdf

Hancocks evidence session....

Page 19:

I was also assured that the UK was one of the best placed countries in the world for responding to a pandemic, and indeed, in some areas, categorised by the World Health Organisation as the best placed in the world.

Pages 22-23:

The attitude, the doctrine of the UK was to plan for the consequences of a disaster: can we buy enough body bags? Where are we going to bury the dead? And that was completely wrong. Of course it's important to have that in case you fail to stop a pandemic, but central to pandemic planning needs to be: how do you stop the disaster from happening in the first place? How do you suppress the virus?

Pages 24-25:

Q: Did you ask or were you made aware that the testing, the diagnostic testing which was in place was on a very small order, and of course was testing designed to deal with a limited high-consequence infectious disease, primarily one involving an outbreak in health settings?
A: Yes, I knew that the testing system was small, and the reason that I explained the flawed doctrine at this point is that by not preparing to stop a pandemic, and worse by explicitly stating in the planning that it would not be possible to stop a pandemic, therefore a huge amount of other things that need to happen when you're trying to stop a pandemic didn't happen, and we had to build them from scratch when the pandemic struck.
For instance, large-scale testing did not exist, and a large-scale contact tracing did not exist, because it was assumed that as soon as there was community transmission, it wouldn't be possible to stop the spread and, therefore, what's the point in contact tracing? That was completely wrong, and in my view is the absolutely central lesson, is: of course the difference between a flu and a coronavirus is important, but it is a -- but it is not nearly as important as getting the doctrine right so in future we're ready to suppress a pandemic, unless the costs of lockdown are greater than the costs that the pandemic would bring.
Q: Perhaps we'll return to the issue of the -- or the doctrinal arguments about lockdowns a little later.
A: If I may, the reason to bring it up is because it had consequences in all the areas you've set out: stockpiles, testing, antivirals, contact tracing and much more widely.

 

[elbows]

Pages 32-34:

Q: So, in effect, the plan failed to provide for a range of scenarios, it focused too much upon an influenza pandemic, of course that's what it was called, and although there was a reference in it, Mr Hancock, to the inherent unpredictability of respiratory viruses, there was no detail, was there, of how, given those inherent unreliable characteristics of a respiratory virus, we could be hit by a non-influenza pandemic which had different characteristics to influenza but could be no less catastrophic?
A: So --
Q: That was the flaw, wasn't it?
A: That was not the main flaw, that was a flaw.
That was of course a problem. However, we also knew there could be another infectious disease and, as I've mentioned, we were dealing with a number of them, and I was cognisant of that. For instance, when we did the work on vaccine production, the plan that was put together was a pandemic disease plan, vaccine plan, not an influenza pandemic vaccine plan. So we were cognisant of that.

A: But I return to my central point, which is that to say that the main problem with that plan was that it was a flu plan and there was -- and we ended up with a coronavirus pandemic is of course a flaw, but it is not the central flaw. If we'd had a flu pandemic, we would have had a massive problem because of the doctrinal failure of how to respond to it as well. That was a much bigger error. It was an error across the western world, but it was a much bigger error, and it is absolutely central. I know that I keep stressing this point, but it is central to what we must learn as a country, that we've got to be able to hit a pandemic hard, that we've got to be able to take action, lockdown action if necessary, that is wider, earlier, more stringent than feels comfortable at the time. And the failure to plan for that was a much bigger flaw in the strategy than the fact that it was targeted at the wrong disease.
Q: They were both major flaws in the strategy, were they not, Mr Hancock?
A: They were both --
Q: It was not just one flaw. You have identified now two major flaws in that strategy.
A: Yes, the point I'm trying to make is that the doctrinal flaw was the biggest by a long way, because if we'd had a flu pandemic, we still would have had the problem of no plan in place for lockdown, no prep for how to do
one, no work on how best to lock down with the least damage.
I know -- I understand deeply the consequences of lockdown and the negative consequences for many, many people, many of which persist to this day. The problem that we faced was that the consequences of not locking down was much worse, and we need to be able to be --I think John Edmunds is excellent in his evidence saying -- and Gus O'Donnell -- saying we need to have a way to calibrate as early as possible: what would the damage be of this if we don't, what would the damage be of this if we do--

In regards Cygnus, pages 38-40:

Q: But, Mr Hancock, why didn't you say to your civil servants -- this was a major exercise into the United Kingdom's pandemic influenza preparedness, it was one of the largest command post exercises ever held, it made a number of important recommendations, 22 in fact in all --
A: Yeah.
Q: -- across the whole board of the United Kingdom's plans and capabilities. And by June 2020 -- after the pandemic had struck, of course -- the DHSC acknowledged that of the 22 recommendations, eight had been fully addressed, six had been partially addressed, and work to address eight more was still ongoing.
How could that have been missed? How could those recommendations not have been put into place between July 2018, when you took that post, and 2020, when the chickens came home to roost?
A: Well, the answer to that question -- there's two ways of answering that question. The first is that as a secretary of state you have a limited set of resources, and you have to make sure that those resources are targeted at the threats that you face, and one of those risks was a disorganised Brexit and it was incumbent on the department to make sure that we were as well prepared for that as possible.
The second way of answering the same question is that it isn't really about the numbers of recommendations from Cygnus, it's about what those recommendations were, and the problem with Cygnus is it did not spot the central problem in pandemic planning.
So I'm -- having looked through those recommendations that were not put in place, I'm not sure they would have helped much when the chickens, as you say, came home to roost. Because Cygnus did not recommend that we should be prepared to stop the spread of a pandemic. It made all sorts of recommendations for how to deal with the worst-case scenario happening.
Therefore, I am not at all convinced that we would have been much better placed to face this pandemic had all of those recommendations been put into place, because -- because there was a much bigger error.
Q: All right. But those exercises take place for good reason, do they not?
A: Yes, but they still -- but it still didn't spot the main problem.
Q: Are they important matters, Mr Hancock?
A: Of course.
Q: And were recommendations made, a number of them, as a result of that exercise?
A: Yes.
Q: And did your department fail to implement all those recommendations?
A: I'm not denying any of that. I'm explaining, firstly, the different pressures that you have on resources, and Brexit was real and a pressure, and I'm also explaining the consequences of those decisions, and I'm -- I'm trying to articulate that there was a much bigger problem that we must -- and the central lesson that I think we need to learn.

 

[elbows]

Pages 52-53:

Q: How many of those overarching meetings, NSC(THRC) meetings, did you go to in order to inform them of those regular progress updates?
A: Personally?
Q: Personally.
A: None that I can remember. I attended the National Security Council from time to time when the agenda included areas that I was responsible for. I was not a standing attendee. But I don't recall ever being asked to attend to report on this.
Q: Did you know of the existence of the NSC(THRC), the ministerial -- overarching ministerial committee to which you were expected to report?
A: Yes, I attended it. That's essentially the National Security Council.
Q: No, the NSC(THRC), the threats, hazards, resilience and contingencies committee.
A: Yes, that's a subcommittee. That one is a subcommittee of the National Security Council.
Q: How many of those subcommittee meetings did you attend?
A: I can't recall.
Q: Did you attend any?
A: I may well have attended none, but I can't recall.
Q: Have you seen any piece of paper that suggests you did attend?
A: No.
Q: Why not?
A: I've no idea. Because the Department for Health was not responsible for the agenda of that, that committee or indeed the wider National Security Council. The attendance of ministers in the Department of Health was determined by whether they were invited.
Q: Mr Hancock, your own department's committee, the board, which it co-chaired with the Cabinet Office, knew full well that you were expected to report to the NSC(THRC) with updates on the board's work. Can you think of any reason why you didn't attend those meetings, why you weren't told about the meetings, why you weren't informed of the expectation that you attend those meetings?
A: The only explanation I can give is that the team faced a significant number of different threats and challenges, and they chose, during the relatively short period I was Secretary of State before the pandemic struck, to focus on other issues that they felt to be appropriate.

Pages 59-60:

Q: Moving forward eight months to the eve of the pandemic, in November 2019, INQ000023089, the minutes for the Pandemic Flu Readiness Board:
"The Pandemic Flu Readiness Board ... has not met since November 2018 due to reprioritisation in 2019 to plan for a potential no-deal EU Exit."
So the sole cross-government body set up by direction of the Prime Minister did not meet at all, did it, between November 2018 and 27 November 2019?
A: That's what this paper says.
Q: Were you aware, Mr Hancock, that for a whole year the board did not even meet?
A: I do not recall being aware of that, no. But also -- but I do know that work under the board's guidance continued, because I was engaged in some of the work, as we've discussed, especially but not only on vaccine manufacturing.
Q: Page 5, paragraphs 7 and 8.
"... PFRB had committed to meet every 6-8 weeks until the key outputs of the work programme were delivered. It is proposed that in 2020 [it] meets every 3 months. This will ensure that progress can be communicated to key planning partners through updated documentation where appropriate."
So it was understood, wasn't it, that although it had committed to meet every six to eight weeks, the failure to meet for a whole year fell very far short of what it had apparently committed itself to doing?
A: That's what I understand too from reading these papers, yeah.

 

[elbows]

Pages 71-72:

A: The influenza strategy refresh, that was a 2011 document, it would -- that would only have been significant if that refresh had completely changed the strategy that the entire western world was following that was regarded as -- by the WHO as best in class --
Q: May I pause you there? Is that the 2011 strategy
A: -- Correct.
Q: -- which, in your witness statement, you state that, for the purposes of pandemic planning was "woefully inadequate"?
A: Woefully inadequate. And --
Q: Thank you.

A: -- I don't think a refresh would have changed that, because all of the independent external advice, the World Health Organisation advice, indeed the International Health Regulations stated that we should not have lockdowns. In fact, in a 2017 document it said:
"The evidence is not strong enough to warrant advocating legislative restrictions."
This is where I need to add to what I've written in my written statement, because I thought at the time it was simply an oversight not to consider lockdowns.
Actually it was an explicit decision. The London Resilience Partnership published document, May 2018, and I quote:
"It will not be possible to halt the spread of a new pandemic ..."
That was the attitude, it was the doctrine, and it was wrong. So that refresh would have made very little difference.

Pages 75-76:

Q: By January 2020, did the department have in place, the department of social care have in place, a single coherent plan to identify vulnerable service users across the country, that is to say how many people are in the care sector?
A: No.
Q: Did it have a central plan for the sharing of data between private and public care providers and emergency responders in order to be able to better prepare them all for a pandemic?
A: Something along those lines was being developed, but it was definitely not in place.
Q: Was there a single national guidance for pandemic preparedness in the adult social care sector?
A: The guidance for pandemic preparedness went through local authorities and so there was not a single one, no.
Q: Did all the LRFs, the local resilience forums, have plans in place on the local authority level for dealing with the impact of a catastrophic pandemic on the elderly?
A: No, they were required to and, as far as I'm aware, only two had done the work.
Q: Was the Department of Health and Social Care able to verify the extent of the pandemic preparedness planning that was being done by local authorities?
A: No, we didn't have the policy levers to do so, despite having the name "Social Care" in the title.
Q: Did the Department of Social Care put into place a national standard by which the plans from the local authority could be gauged?
A: No.

 

[elbows]

Pages 78-79, where Hancock makes the point that actually flu plans assume asymptomatic transmission, but initial assumptions about coronaviruses only involved symptomatic transmission:

Q: Proposition 2: there was a failure to think through properly the risks of a non-influenza pandemic. Due to the inherent unpredictability of viral respiratory pathogens, and their characteristics -- as you say, transmission rate, high or stuttering; incubation period, long or short; viral loads, great or less; whether viruses congregate in the upper or lower respiratory tract -- whatever they may have been, because those other characteristics were simply not thought about enough, the real risk of an HCID with catastrophic consequences was not adequately thought about either?
A: I wouldn't put it like that, and I think there's an irony here. The irony is that one of the major problems we had early on, which I'm sure we'll come to in M2, was the fact that Covid-19 has asymptomatic transmission. It's the first known coronavirus that affects humans that can be transmitted asymptomatically, and the WHO assumption was that this wasn't possible until April 2020. There is a really important reason I'm saying this. A flu plan assumes asymptomatic transmission.
Q: Indeed.
A: There are some ways in which the flu plan was, in fact, more appropriate as a planning document than a generic document or, indeed, a document that had been written to consider the impact of one of the then known coronaviruses, because that plan, a coronavirus pandemic plan, would have assumed no asymptomatic transmission.
So this underpins my point that of course it would have been better to plan for a generic, you know, respiratory Disease X, and that is what we should do in future, however, planning for the flu -- planning for flu did have some benefits, and it brings me back to my central contention that, whilst this was an error, it was in no way the biggest error. And it's not just that there were two errors in the core plan, you know, flu rather than coronavirus and wrong doctrine; the error of the flawed doctrine was significantly bigger than the error of targeting a flu rather than a coronavirus pandemic.

Pages 81-83. Note the lead counsel repeating the same stuff about flu being symptomatic, failing to learn from what has been said on a number of occasions during the first weeks of evidence, and Hancocks failure to notice and correct him despite this being relevant to the point Hancock made just minutes earlier:

A: So the theory written down in these strategies was actually not what was playing out in the day-to-day practice of infectious disease management that we were undertaking as a department and that PHE was undertaking.
Q: But, Mr Hancock, it's not just a question of irony, is it? These failing materially hampered the United Kingdom's ability to prevent death?
A: The central failing that hampered the UK's response, common with the rest of the western world, was the refusal and the explicit -- the explicit decision that it would not be possible to halt the spread of a new pandemic. That is wrong, and that is at the centre of the failure of preparation. I know that, because I was the person responsible, as the Category 1 responder, when this pandemic struck.

All of the other considerations are small -- important but small -- compared to the colossal scale of failure in the assumption that it will not be possible, and the lack of ambition in the assumption that you can't stop the spread of a disease. We can.
You know, imagine if this disease had tragically killed children as much as it did old people, and maybe it transmitted twice as easily as Covid; would it then be possible to halt the spread? Of course it would. We would do whatever it took.
And that's where we got to. But we got there far, far too slowly, because none of the preparation included any thinking around that.

Q: That is my fourth proposition, it's the one that finds a place at the front of your witness statement, it is that there was a failure, a complete systemic failure to think about how to prevent catastrophic consequences arising at all, as opposed to how to manage catastrophic consequences which were assumed to result?
A: I couldn't agree more, and it's an absolute tragedy. Number 5: there was an associated failure to think about countermeasures.
Q: Because, of course, flu has a shorter incubation period, it is symptomatic, there are antivirals, there are vaccines available. There was, therefore, a failure to think about, in the way that other countries, particularly in the Far East, had done, countermeasures such as mandatory quarantines?
A: Yes.
Q: Shielding?
A: Yeah.
Q: Social restrictions?
A: Yes.
Q: Border control?
A: Yes.

Q: There was, as you say, a complete lack of imagination?
A: Yes. I had to overrule the initial advice not to quarantine people being brought back from Wuhan.
I mean, that is -- it is madness. And it was written into the International Health Regulations that you shouldn't close borders.
This was not a UK problem, it was a World Health Organisation problem, and the World Health Organisation, of all people, should have learned the lessons from MERS and SARS.
So we had diligent, hard working teams working on this pandemic preparedness, but there was an absolutely central doctrinal failure in the response of the UK and almost every other western country.

 

[elbows]

Pages 95-96:

Q: All right. I don't want to ask you to address the solutions or, in fact, to identify the specific problems that arose, only to acknowledge that there were very real difficulties in these areas.
A: I see. Yes, of course.
Q: The availability of mass diagnostic testing --
A: Yes.
Q: -- you've already referred to.
A: Terrible.
Q: The availability of mass contact tracing systems.
A: Yes, there was no such thing.

Q: Obviously there are the NHS-related issues concerning resilience, bed capacity, workforce planning, all of which are issues which you've referred to --
Yes, there's a bigger thing there as well within the NHS, which is that, you know, whilst the discussion on how much resources the NHS should get is a highly political one, and we've seen it play out over the last couple of weeks in this Inquiry, there is actually a really big question that the nation needs to ask itself, which is that -- you wouldn't ever send the whole of your army out into battle at once. You have spare capacity in case there's a crisis. You have what they call redundancy in the military sense. Yet every single day we send our whole army of the NHS out into the field and there is no redundancy. We run the NHS incredibly tight. It's an incredibly efficient organisation in the grand scheme of things. Despite obvious areas that can be improved, it is overall run very tight, and that means that there simply isn't the resilience when a crisis comes. But that would require a materially huge increase in the already very, very large NHS budget.

But other countries choose to spend a higher proportion of GDP on healthcare and have that redundancy, and it means that they are better able to respond.
But it also comes back to doctrine, because no health system of any size would be able to respond unless you suppress a virus when it's as bad as Covid-19.
Q: But as my Lady has already observed in another context, there are choices that will have to be made, and there is, therefore, an issue about resilience and about bed capacity and surge capacity and so on --
A: Absolutely.
Q: -- for the future?
A: Absolutely.

Page 97:

Q: There's an issue about the necessary degree of co-ordination across the United Kingdom, given the fact that health security is a devolved issue --
A: Yes.
Q: -- but at the same time, of course, viruses honour no boundaries.
Then, finally, you say that --
A: Well, they honour geographic boundaries, they honour no administrative boundaries. The fact that we are an island is an advantage that we should use much more aggressively in future in preventing a pandemic coming here.

Pages 99-101:

A: The life expectancy of a man born in Blackpool is 15 years less than a man born in Buckinghamshire, and I appointed Chris Whitty to the CMO job based on his proposal that he wanted to do everything that we could to address this. So health inequalities were right at the forefront of his and my agenda. Of course the different impact clinically of a virus on different groups is absolutely front of mind, and implicit in all of the planning.
Q: Well, that's obvious, as I've suggested to you --
A: It has to be. But in terms of the social and socio-economic impacts, all I would say is that an assumption that you're not going to stop a pandemic running through the population is implicitly an assumption and a decision that those most vulnerable to it will be hardest hit. So the single best thing we can do to protect those who are most vulnerable is stop viruses from killing hundreds of thousands of people.
It brings me -- and we end on the central -- my central contention, which is you've got to work out -- there are costs to lockdown, you've got to work out whether the impact of the virus is going to be worse than the costs of lockdown, and if it is going to be worse, as was the case with Covid-19, you've got to hit it hard and very, very early.

 

[elbows]

Page 103, where they are on to final questions asked by Covid-19 Bereaved Families for Justice rather than the inquiries lead counsel:

Q: You have already indicated to Mr Keith that the 2011 doctrine strategy was woefully inadequate?
A: Yes.
Q: And you put that in your statement?
A: Yes.
Q: I just want to read that one paragraph from your statement to flesh that out.
A: Yes.
Q: This is your words:
"Clearly the approach in the 2011 strategy was woefully inadequate. I have no idea why the 2011 strategy did not consider the approach taken by countries affected by SARS, and learn the lessons for the UK. I also do not know why the WHO considered the UK one of the best prepared countries in the world, when our strategic approach did not consider it possible to take social distancing measures necessary to stop the spread of a killer disease."
A: Yes.
Q: Yes? So you're emphasising the lack of learning and the emphasis around social distancing measures?
A: Yes.
Q: That would, of course, include lockdowns?
A: Absolutely.

There is then a rather long bit where they get into some recommendations WHO gave, and whether the UK put those in its draft flu pandemic bill (which was later used to create the covid bill). Its a bit too sprawling to quote from properly here and gets bogged down in issues such as what measures the UK didnt need to put in the new bill because they were already covered by much older health legislation from the 1980s, and quite how far the WHO meant the advice to go when it used terms like mitigation. Hopefully there will be another opportunity to explore these themes later. Because although UK pandemic plans and the doctrine Hancock keeps going on about (and that I always went on about using the term orthodox approach) didnt involve anything like lockdowns, its always interesting to look at what sort of draconian stuff they still had in the back of their minds when coming up with emergency powers.

Then on page 114-115 Bereaved Families for Justice Cymru sent an email because they had noticed a contradiction when Hancock claimed that previous thinking about coronaviruses assumed only symptomatic spread:

My Lady, we've received an email from Covid-19 Bereaved Families for Justice Cymru who wish, I think perhaps vicariously, to ask permission for a point to be put to Mr Hancock, who said in the course of his evidence that coronavirus was the first coronavirus known to be -- or the first coronavirus that could be transmitted asymptomatically. The position is, as the chart that you directed be prepared amply demonstrates, that MERS and SARS were also -- are also asymptomatically transmitted, and therefore there is clear evidence to correct that position.

To which Hancock started to explain that he had been briefed otherwise but that this stuff will be covered in module 2:

Q: Perhaps I could be permitted to ask you one question, Mr Hancock, in light of the question from Covid-19 Bereaved Families for Justice Cymru.
The transmission rates in relation to MERS and SARS-1 --
A: Yes.
Q: -- are of course very different to Covid?
A: Yes. What I stated was the clinical fact, as I was advised at the -- during the debate about asymptomatic transmission, which no doubt we'll cover in M2 because it was absolutely central to the challenges of the early response to the pandemic.

 

[elbows]

I'm only going to quote this bit from page 27 because of what he says at the very end of it:

If I may say so, I am profoundly sorry for the impact that had. I'm profoundly sorry for each death that has occurred. And I also understand why for some it will be hard to take that apology from me.
I understand that. I get it. But it is honest and heartfelt. And I'm not very good at talking about my emotions and how I feel, but that is honest and true, and all I can do is ensure that this Inquiry gets to the bottom of it and that for the future we learn the right lessons so that we stop a pandemic in its tracks much, much earlier, and that we have the systems in place ready to do that. Because I'm worried that they're being dismantled as we speak.

I think thats the end of my Hancock quotes for this module. As you may imagine the number of quotes I've had to fish out in recent days has worn me out, so I might have to take an extra break during a lot of the witnesses from Scotland who are ont he timetable for the rest of this weeks evidence. I still intend to quote from them, but maybe not till some days later.

The final witness of the day after Hancock was done was the Public Health England head during a long period while that entity still existed, and most of what was covered is not stuff I feel the need to quote. I'll double-check tomorrow, but for now I will only pick out this single quote:

Duncan Selbie, page 167:

And, finally, people publish things, they say things, they go out and they say what they care about, but these days I'm not interested in that, I'm interested in: show me your budget and then I'll know what you care about. Don't show me your strategy and don't tell me that you care about health improvement and inequalities; show me a budget and then I'll know whether you do.

 

[elbows]

Oh and I do feel bad for the times that health inequalities of various sorts have come up in the evidence in ways I have struggled to quote effectively. So I will stick up a graphic they showed during the Duncan Selbie session, showing life expectancy rates varying across the country (not pandemic-specific, data is from years before the pandemic struck). The picture is very stark.

 

[elbows]

Oops there was one more Hancock quote I meant to include.

Page 90:

In this country this year we've spent £53 billion on physical military defence. UKHSA's core budget is £450 million, that's less than 1%, and yet over 220,000 people died of Covid -- have died of Covid so far.
The impact on the health of the nation and the well-being of the nation of health protection is an order of magnitude bigger than as currently represented in the UKHSA budget, and the idea that we spend over 50 billion on defence and under 500 million on UKHSA is, for me, completely indefensible.

 

[elbows]

An inquiry thread in the UK politics forum points to a twitter thread which attempted to expose Hancocks 'doctrinal' excuse as being entirely bogus. I give my thoughts on that there, its a complex picture, some of it is a crap excuse that ignores variations in approach between nations, but the twitter thread itself seems ignorant of the extent to which the do little approach was a very longstanding part of the UK orthodoxy that was sadly not limited to tories in power:

#65

 

[elbows]

I am interested in Scotland but yesterdays evidence was rather dull so I shall probably not be quoting from it. Perhaps I'll find time to make one or two exceptions, for example there was a little bit of talk about how inadequate their PPE fit testing was. And a common theme that comes up in relation to Scotland is that, unsurprisingly, they have concepts surrounding health inequalities more firmly baked into the language and stated aims of various documents and health entities there. But obviously there is a difference between merely paying lip service to such things and actually doing something about that issue to the extent that it would make a big difference in a pandemic.

Jeremy Farrarr was on first today and I will probably quote a few things from him later, even though it covers much the same ground as others have already dealt with.

Now its Sturgeon. Her narrative has been affected by the fact that at some point during the pandemic, after the first wave had passed, Scotland correctly figured out that maximum suppression of the virus would be a good thing. Unfortunately I saw few signs that they actually had the tools and will to do this any more than the rest of the UK did, and so the main difference this made was only to their rhetoric. There was a period where she was emulating the rheotric from New Zealand etc without the policies to match, with only a few exceptions, usually ones that involved being at odds with the UK government and having a bit of a scrap in public. And now I have to sit through the spectacle of her applying this same concept retroactively, by claiming that their existing pandemic plan and attitudes prior to this pandemic arriving was not just about dealing with the consequences of a worst case scenario, but also involved actually trying to suppress the virus. There is no way this claim will stand up to proper scrutiny, but such scrutiny wont really happen in this module anyway, it will be a matter for module 2. And I wont bank on it happening properly in module 2 either, not if the counsel for the inquiry just repeatedly stick to a handful of specific and fairly rigid lines of focus as they seem to be doing in module 1.

 

[elbows]

I have continued to listen to most of the ongoing witness questioning since I last posted. Huge amounts of repetitive and tedious detail about bureaucratic structures, planning failures, resource limitations due to hard brexit planning have limited my ability to pluck out the stuff that doesnt fall into this category. Its been quite mind-numbing for hours on end. I still plan to try at some point when I have more time. For example some Scottish and Welsh witnesses highlighted poor communications with the UK government. And Covid Bereaved Families for Justice Cymru developed a line of questioning across a number of witnesses that involved hospital infection controls, missed opportunities to learn from SARS, and someones warning from 2013 about novel disease pandemics.

Mark Woolhouse is coming up this afternoon. He was someone who I was very rude about in 2020 due to certain things he said and did. But he said far more sensible things in 2021 and 2022.