UK Inquiry Module 2: Decision-making & political governance

[elbows]

Submissions on behalf of Covid-19 Bereaved Families for Justice UK by MR WEATHERBY KC

Pages 117-118:

In January 2020 Lord Bethell was the government health whip in the House of Lords, and in March 2020 he became a minister in the Department of Health and Social Care. This is what he said in a recent interview with the Institute for Government, which was widely reported: "By mid-January, we in the top floor of the DHSC had a pretty clear idea of what the train was looking like coming down the tracks." He then said this:
"No 10 didn't want to prioritise the pandemic in early 2020, even though the evidence was mounting -- here was a post-election, ostrich head-in-the-sand mentality ... its priority, and what we were told many times, was Brexit and levelling-up. 'We have to deliver Brexit, so could your pandemic quietly go and mind your own business, please', we were told. After that, we got a lot of erratic dipping-in -- in Yiddish, it's called 'kibbitzing', erratic and ill-informed interference."

We pose the following questions: how many lives would have been saved if there had been a whole-system pandemic plan, proper resilience within the health and social care systems, a minister responsible for civil emergencies, a standing scientific committee on pandemics, a proper collaborative framework for working with the Scottish, Welsh and Northern Ireland devolved administrations, and also with local authorities? Many lives would have been saved, is the answer that we would provide.

Pages 119-120:

Mr Johnson himself appears set to paint a rose-tinted account to this Inquiry, and recently he asserted that the United Kingdom "defied most of the gloomier predictions and has ended the pandemic ... well down the league tables for excess mortality".
Is that really so? Well, according to an analysis by the John Moores University of Medicine cited in our written submissions, per head of population the United Kingdom was the number 20 worst of 173 countries in terms of the number of deaths.
Was the outcome really as good as Mr Johnson pretends? It will not surprise you that the 7,000 bereaved family members we represent will beg to differ.
The bereaved families want vital questions answered. They want candour from public representatives and public servants, not self-serving justifications, bluster and downright fiction. They present 230,000 reasons why Mr Johnson's "we didn't do too badly" opening gambit should be rejected.

Pages 120-122:

...it appears that the starting point was that Mr Johnson failed to take the emerging threat seriously. Initially he will tell us that he thought it was just a scare, and in his statement he says that the impact of the Creutzfeld Jakob disease was initially overstated.He refers to a "bird flu scare" when he was Mayor of London, and he remarks that the 30 January WHO declaration of Covid as a public health emergency of international concern was just one of a number since 2009.

Deputy Chief Medical Officer Jonathan Van-Tam will tell us that as early as 16 January he was "certain that the UK would be struck by a severe pandemic".

Mr Hancock will tell us that by 22 January he was warning Mr Johnson directly in a phone call that there was a 50% chance that the virus would escape China and, in his words, "go global", and that a "very large number of people would likely die". Mr Johnson says he doesn't recall this conversation, a somewhat surprising assertion, given its content. Mr Hancock will also tell us that Number 10 refused his request for COBR, the central government emergency committee, to be stood up until 24 January, calling him "alarmist".

In a WhatsApp exchange on 25 January, Dominic Cummings asked him about the extent of preparedness for a pandemic. Mr Hancock replied, "We have full plans up to and including pandemic level regularly prepped and refreshed". It will be interesting to see how he squares that assertion with his Module 1 assessment that the UK level of preparedness was "woefully inadequate".
Of course, Mr Cummings was the PM's Chief of Staff at this time. For reasons which are unclear to us, his statement and documents have yet to be disclosed, as indeed has the content of Mr Johnson's phone from this period, so I'm unable to take this part of the story too much further, as to what was behind this request of Mr Hancock.

Pages 125-127:

In April, The Sunday Times ran an article headlined "38 days when Britain sleepwalked into disaster". The thrust of the article was that the UK sleepwalked into widespread community infection, with little action to slow it or prepare for the worst that was to come. It struck a chord at the DHSC, which, unusually, put out a detailed rebuttal, asserting in the strongest of language that "the article contains a series of falsehoods and errors and actively misrepresents".
Now, I'm not here to defend The Sunday Times. I'll leave that to the government's Chief Scientific Adviser, Patrick Vallance. His contemporary notes say:
"The [Sunday Times] got it about right. We warned of pandemic flu level deaths in January. [Matt Hancock] kept too much in DHSC and didn't move fast enough. [The Civil Contingencies Secretariat] was slow as well."

In a different entry, in April, Professor Vallance quotes Matt Hancock admonishing him: "Science advice we can't do because of supplies, is worse than useless."
The clear inference is that certain ministers were not so much following the science as wanting cover from scientific advisers for shortcomings in provisions. Here it was masks.

The theme continued with the change of designation of Covid as being a high-consequence infectious disease; as we know it was designated as such on 16 January, given that it had the potential to spread widely and with large scale fatal consequences. But on 19 March as the UK slid into the first devastating wave, the UK downgraded the designation of the virus, no longer categorising it as an HCID. As we understand it, without advice or consulting SAGE.
The effect of downgrading was to reduce the standards of PPE required by healthcare guidance. Or moving the goalposts to avoid criticism might be a way that we would put it.

 

[elbows]

Continuing that, we see the asymptomatic excuse being used, as well as another notorious spectacle from Johnson:

Pages 127-128:

We'll hear from Mr Johnson that scientific advice is also responsible for poor decisions. He will suggest that there was no evidence of asymptomatic transmission, and that explains why the risks were underestimated in the early months.

We'll hear from Mr Hancock that there was a global scientific consensus until April 2020 that the virus did not transmit asymptomatically. That is completely untrue. The High Court unpicked this issue in its judgment in the Gardner case. The 29 January COBR meeting already referred to was briefed that there were early indications of asymptomatic transmission. The Professor Woolhouse emails referred to earlier noted that by 31 January there was growing evidence of asymptomatic transmission. By mid-March Patrick Vallance was publicly saying on the Today programme that asymptomatic transmission was a probability. It's important to note that this very public acknowledgement by Professor Vallance came just four days before the decision on 17 March 2020 to discharge 30,000 patients from hospitals without testing, many to care homes.

Mr Keith has already referred to the fact it was two months into the emergency before Mr Johnson attended his first COBR meeting, 2 March. The day before he engaged in what can only be described as cavalier and incredibly unhelpful public messaging when he visited the Royal Free Hospital, telling the media, "I think there were a few coronavirus patients and I shook hands with everybody, you will be pleased to know, and I continue to shake hands".
We now know he received a briefing the night before his hospital visit expressly referring to transmission by touching an infected person. It's difficult to see his actions and media comments as other than dismissive of a disaster which had been looming for two months and was now just around the corner.

They then give some examples of people who died as a result of failure to cancel mass sports events and some other activities.

I havent had time to quote much stuff in relation to the devolved administrations in either of the first two modules so far, but I note this from page 132:

Mr Johnson has commented that he put Mr Gove in charge of the relationship with the devolved administrations because he didn't want there to be a "mini EU" of four nations. That will be an issue which will need some explaining and unpicking.

 

[elbows]

Page 134:

It's simply not correct that the pandemic affected us all equally. So far as we can see, as with the preparedness evidence in Module 1, structural discrimination was an elephant in the emergency response room. There's scant evidence that it was considered at all.

Eat Out to Help Out again, pages 134-135:

When the government ended the first lockdown, it appears that its decision-making got no less erratic. Mr Keith has mentioned the Eat Out to Help Out policy, which involved subsidising people who were coming out of a lockdown designed to minimise social gatherings to gather with others in enclosed spaces. Explained as an economic recovery measure, it appears that it was rolled out without any scientific advice. We anticipate that scientists will say their advice would have been strongly against such a hare-brained scheme. The Inquiry will have to consider whether the government really was following the science, or whether Mr Sunak's flagship policy hastened the next wave of infections.

Another death is then described in conjunction with a lack of PPE for domicillary care workers. Then on page 136:

The families have real concerns that the ongoing failures of policy and erratic response firstly led to mass discharges of mainly older patients from hospitals to care facilities without testing, causing greater transmission into the most vulnerable settings, and then led to the under-admission of older people who needed hospital treatment and the triaging of patients resulting in the restriction of critical care for older and vulnerable people and the inappropriate use of DNACPRs. The families raise issues about dignity too, the treatment of the deceased and of the bereaved in terms of cultural norms and funerals, as you saw powerfully in the impact films this morning.

Then there are the bereaved family groups for the other UK nations. I wont quote much from these but of particular wider note from pages 151-152 via the Northern Ireland bereaved group:

Professor Medley warned starkly, just one month later, in April 2020, that his reading of the situation is that:
"We have widespread ongoing transmission in the health and social care systems. Hospital and community health and social care appear to be driving transmission and potentially at an increasing rate. In effect, this is the opposite of shielding, the vulnerable are being preferentially infected."

The bereaved group from Wales ended up with a stand-in delivering their opening remarks, since the original participant was unavailable due to catching Covid.

Then there were opening statements from representatives of all the other core participants for this module. I already mentioned the revelation about Johnson calling Long Covid bollocks earlier, here is a different version of it from the opening remarks by the representative for "Long Covid Kids, Long Covid SOS and Long Covid Support", pages 179-180:

In October 2020 while the DHSC was publishing guidance on long Covid and called for recognition and support for people with long Covid, then Prime Minister Boris Johnson scrawled in capitals that long Covid was "bollocks". Mr Johnson has admitted in his witness statement that he didn't believe long Covid truly existed, dismissing it as "Gulf War syndrome stuff". The Inquiry will be concerned to probe how the former Prime Minister could possibly hold this view in October 2020, when SAGE, NERVTAG, DHSC, NHS, the WHO, and patient advocates around the world had recognised and registered the risk that long Covid was already posing with its own unique global ICD classification of the disease. The Inquiry will no doubt wish to carefully scrutinise whether the science was followed. It is perhaps noticeable that the former Prime Minister now accepts that long Covid is a serious health condition, but does not say when he changed his mind.

Also from them on page 184:

Their analysis of risk was distorted, overlooking the very real impact of long-term and disabling health consequences. Professor Whitty acknowledges the shortcomings of not recognising the risk of long Covid, saying that when they did, "it made
us more cautious of the effects of Covid-19 in young and otherwise healthy adults as the pandemic progressed".

The failure to integrate the risk of long Covid into pandemic decision-making continued throughout all the lockdowns and into the government's exit strategy in preparing for "Freedom Day".

When we look at the evidence, it prompts the question: was long Covid overlooked or was it dismissed? Minutes from a Covid-O meeting on 5 July 2021 suggest a dismissive attitude to long Covid persisted when it was recorded, alarmingly, that long Covid should not be used loosely, as it described a number of syndromes at a time when personal independent payment claims had reached an all time high.

 

[elbows]

From opening remarks on behald of Disabled Peoples Organisations. Another subject I cannot do justice to via short quotes but feel compelled to include a few anyway:

Snippets from pages 187-189 :

Disabled people are 20% of the UK population and six out of ten of the Covid dead. That should make their fate one of the most significant of public issues, but it is not. The DPO therefore suggests an essential starting point for the Inquiry, that the bulk of disabled people's fatal and damaging outcomes during the pandemic were chosen. They were the product of the way our society is organised, and the dominant values and beliefs that guide it. Our clients use the terminology of disabled people because people are disabled by the fact that social spaces, services and provisions are modelled around certain kinds of bodies and minds to the disadvantage of others.

Inequality is now a core issue in this Inquiry, but during the pandemic these matters were initially not spoken of, or characterised with euphemisms such as "disparities" or "non-clinical vulnerability"; anything other than the made inequalities and inequities that they are.

Austerity had particularly severe consequences for disabled people. It is perverse for its architects to suggest otherwise.

The person the government imagined when it told us all to stay at home was someone who could financially, physically and logistically afford to stay there. It did not imagine the person who had no spare room to isolate in, the person dependent on assistance from others, the person who could not stay at home or isolate within it because they need to care for someone else or because they could not survive without going out to work. Instead, it imagined a non-disabled, autonomous person who would regard their home as a place of safety and be capable of moving their life into it.

 

[elbows]

And so onto day 2 (last Wednesday). First there were a bunch more opening statements. Some of them were from tedious core participants such as those within government or the devolved administrations, so I'm skipping those. And again I cant do the ones about children, ethnic minorities, women, workers and medical professionals (via the BMA) proper justice at all, so just some snippets from a few of those...

Day 2 transcript: 2023-10-04-Module-2-Day-2-Transcript.pdf

Page 2:

We know that on the eve of the pandemic the state of children's rights in the UK was bleak. Among almost a third of the more than 14 million children in the UK lived in poverty following a decade of austerity.
We know that following the pandemic that poverty has increased for children, and inequalities have widened, the gap in educational attainment between wealthier and poorer children has increased by 46%.

Pages 4-5:

It is, therefore, undeniable, we say, that the pandemic disproportionately impacted children, and we say because the UK Government did not sufficiently consider children's rights and wellbeing in their political and administrative decision-making. You, my Lady, have already concluded that it is not necessary for the then Secretary of State for Education, Gavin Williamson, to be called during Module 2 hearings and asked about high level decision-making processes, because it appears he was largely excluded from those decisions. This, we say, effectively proves our very point.

 

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Page 20:

So while women experiencing domestic abuse were facing a double threat of domestic abuse and coronavirus, migrant women, particularly those subject to NRPF, were living through the triple threat of domestic abuse, coronavirus and fear of destitution and deportation.

We do not suggest that self-isolation regulations or lockdown were unnecessary, nor do we suggest that government could have entirely prevented domestic abuse rising during lockdown, but we do say that the inevitable increase was far from government's mind when considering NPIs, that government failed to plan for that rise, and failed to put in place remedial measures in advance of lockdown.

Page 23-24:

That lack of clarity in messaging is best illustrated by noting that the Prime Minister throughout the whole of 2020, while announcing various lockdowns, tiers, and the different regulations for Christmas, which is of course a time when there is traditionally a spike in domestic abuse, did not once mention domestic abuse as a permitted reason to leave home. His first mention of it came on 4 January 2021 when he announced the third lockdown

 

[elbows]

TUC, pages 31-32, Eat Out to Help Out again:

Eat Out to Help Out is a striking example. The aim of supporting the hospitality industry was a perfectly valid and important one, but there needed to be some careful thought as to how the scheme fitted within the overall strategy. What we find is that it was a Treasury scheme about which neither SAGE nor the Department of Health and Social Care were even consulted. That is a microcosm of repeated failures to make decisions which pursued a coherent plan with support across government.

So decision-making flitted between resisting certain NPIs, including lockdowns, at all costs before eventually accepting their inevitability.

In a WhatsApp message Simon Case described a particular decision as "A classic of the Johnson era -- go fast, no go slower, listen to me, no agree it with Rishi ...!"

That may ultimately prove to be an apt summary for much of the core political decision-making in response to the pandemic.

 

[elbows]

TUC pages 33-34:

Sir Patrick Vallance, in his evening diary, recorded on 21 August 2020:
"[Chief Medical Officer] said clearly that financial support for people self-isolating is key. [Cabinet Office] working through mechanisms (very slowly)."
On 7 September 2020 he wrote:
"[Chancellor] blocking all notion of paying to get people to isolate despite all the evidence that this will be needed."

So it was that the UK Government response was meagre. At the very end of September 2020, months into the pandemic, the self-isolation support scheme was established. Local authorities were given £50 million to fund the scheme. To give that some perspective, my Lady, £70 billion was spent on the furlough scheme and £840 million was spent in the month of August 2020 encouraging the public to use restaurants.

The TUC subsequently reported that local authorities were rejecting 70% of applications and only a fifth of workers had even heard of the scheme. It was far too little, far too late. The scheme really was tokenisticand devoid of any real commitment to supporting low income workers in high-risk workplaces.

Pages 36-38:

Just by way of example, key guidance produced by the Department of Business, Energy and Industrial Strategy on the return to work after the first lockdown was provided to the TUC on a Sunday morning, with a 12-hour response time. The TUC did respond with a number of concerns raised but the consultation was for too late to be meaningful.

All of this reflects an approach which values the economics of work but neglected its safety. That impacted particularly low income and often vulnerable workers who worked in occupations with exposure to the virus.

After the first lockdown, the mantra was to keep schools open. That was a worthy imperative, but the mantra resulted in a pursuit of that objective until it became impossible to continue. It led to hiding from the science rather than being guided by it, until ignoring it was impossible.

Sir Patrick Vallance noted the Prime Minister saying in a Covid-S meeting on 6 August 2020: "Don't want to hear about plan B and C for failure. I just want pupils back at school."

My Lady, the methodology of "don't have a plan B because you might end up using it" is, in the face of a virus such as Covid-19, indefensible.

Ultimately there was the farcical scenario of thousands of primary school children returning to school and mixing for a single day on 4 January 2021 before a U-turn was announced and schools closed again. It is one of the most striking examples of the bullish pursuit of one particular objective, founded on hope against hope, until such pursuit becomes impossible.

Education unions were frequently concerned by a lack of government transparency about school attendance and transmission, so it is a concern to see reference in the Vallance diaries to the Department of Education declining to raise questions of SAGE because the minutes would be published.

These are important issues which fall within the scope of this module. That Sir Gavin Williamson is not on the witness list appears to the education unions to be an omission, however incidental his role may in fact have been, and the Inquiry is invited to rectify it.

 

[elbows]

Federation of Ethnic Minority Healthcare Organisations:

Page 44:

65% to 76% of the Covid-related deaths reported in clinical healthcare workers, despite only making up 20% of the NHS workforce.

On 10 April 2020, less than three weeks after the national lockdown was declared, the British Medical Association warned that the first ten NHS doctors to die from the virus were from black, Asian or from minority ethnic backgrounds. The numbers are alarmingly shocking and speak for themselves. The disproportionate impact of Covid on communities of colour is not just statistical, it is deeply human.

Page 45:

A decision of note was the downgrading of the Covid-19 from a high-consequence infectious disease status, which dictated the type of protective equipment that would be used. This decision, we say, contradicted robust scientific evidence at the time and adversely impacted on the safety of FEHMO members. Whilst some initiatives were launched, such as the FFP3 fit testing project aimed at accommodating diverse facial profiles, they lacked urgency, were inconsistently implemented across healthcare settings.

 

[elbows]

British Medical Association:

Pages 49-50:

The British Medical Association, the BMA, believes that the United Kingdom Government's response to the pandemic was categorised by a failure to take a sufficiently precautionary approach and by missed opportunities to learn lessons as the pandemic progressed.

The mandating of face masks for the general public was also introduced far too late, and much later than in many other countries. Since 25 April the BMA had been calling for the introduction of face coverings for the public. However, in England they only became mandatory on public transport and for outpatients and hospital visitors from 15 June, and it was not until 24 July that they were required in shops and supermarkets.

Pages 51-52:

The UK Government failed to provide clear, consistent and visible public health messaging.

For example, there was unclear messaging between 16 and 23 March 2020, when the public were encouraged but not required to change their behaviour. The Eat Out to Help Out initiative encouraged social mixing and confused public health messaging during 2020, suggesting that it was safe for people to socialise before vaccines were available and when the risks of Covid-19 remained high.

In 2020 alone, the government campaign around working from home initially encouraged it, then required it, then encouraged it again, then strongly discouraged it, then encouraged it again and then required it again. This pattern continued throughout 2021, and into 2022.

This lack of clarity and consistency undermined the public's understanding of and confidence in core public health messaging.

Pages 53-55:

A key failure of government decision-making was and continues to be the failure to properly consider and acknowledge that Covid-19 is an airborne virus. This impacted on the protections available to healthcare workers. Deficiencies in IPC guidance meant that respiratory protective equipment, or RPE, which provides the greatest protection against aerosols, was not always provided to staff who were treating patients with confirmed or suspected Covid-19, and that fluid-resistant surgical masks were wrongly deemed to be suitable protection.

There is also evidence before the Inquiry that the lack of availability of respirators was because cost considerations were prioritised ahead of safety.

Risk assessments are mandatory under health and safety law and are an important tool in ensuring that employees are safe and protected at work, yet these were often not performed or were inadequate, particularly during the first wave of Covid-19.

In response to these failures, the BMA asked NHS England in April 2020 to develop a national risk profiling framework to assist employers in conducting risk assessments. However, it was not until 24 June 2020, three months into the pandemic, that NHS England issued a letter reminding employers of their legal responsibilities to undertake risk assessments.

Shockingly, analysis by the Health Service Journal found that 94% of doctors who died up to April 2020 were from ethnic minority backgrounds, even though this group makes up only 44% of NHS medical staff.

That concludes everything from the opening statements that I wanted to quote.

 

[elbows]

The first few witnesses, who gave evidence on Wednesday and suffered bereavements during the pandemic. I cannot do their personal stories justice via selective quoting, so I will not try.

I would characterise some of the key themes as:

NHS 111 and dodgy triage including being left at home till it was far too late.

The emphasis on care home outbreaks in the press, and how members of bereaved family groups therefore only discovered when comparing notes with each other later that nosocomial infections (hospital etc acquired infections) were a huge deal, not just isolated events, which were responsible for a large chunk of the bereavements their group members had experienced.

The next bunch of witnesses were experts or advocates of various sorts who had been asked to prepare reports or statements to the inquiry dealing with various forms of inequality, discrimination and pandemic hardship. Again its hard for me to do their reports justice, and indeed the oral evidence the inquiry sought over these next few days often did not attempt to delve deeply into their evidence,. It seems clear that this module is being done at quite the pace, that scope for questioning is somewhat limited, and that looking at peoples full written submissions will often be necessary. I might still try to quote from some of these initial witnesses tomorrow as I catch up with details from last Thursday and Fridays sessions, it partly depends how much of my time tomorrows witness evidence occupies me for. Unusually for this inquiry, they are sitting on all 5 days this week rather than just 4.

 

[wemakeyousoundb]

thank you for all this elbows

 

[elbows]

So, as mentioned previous the first few days of witnesses have been a mixture of experts who have written reports, and in some cases groups including charities who advocate stuff. And as expected I cant do it justice with a few quotes from the oral evidence sessions. So I'm just going to provide a rough outline of the groups and recurring themes, and just a few quotes on very particular subjects which I did have time to grab.

Areas covered: Ethnic minorities, children, older people, women, workers, people with disabilities, LGTBQ+ people.

Themes included:

• Not being listened to by government.
• Lack of government ambition.
• Lack of data to help understand the reality and the challenges various people and sectors faced.
• Crap establishment priorities.
• Digital divide, digital exclusion.
• Poverty.
• Austerity.
• Structural and institutional discrimination.
• Complicated, hard to understand information campaigns that didnt cater for the wide array of audiences with particular needs and challenges.
• Lack of resources or inability to access to resources/services.
• Suspicions that crude indexes of frailty could be used to deny certain groups treatment (dodgy triage stuff has already come up multiple times in the opening days, and will be explored in more depth in another inquiry module)

 

[elbows]

On the theme of children, I had time to grab the following quotes from the day 4 transcript: https://covid19.public-inquiry.uk/w...1100/2023-10-06-Module-2-Day-4-Transcript.pdf

Page 44-45:

But I think what you saw in other countries was, you know, governments making a decision to take over public buildings next to schools so you'd have more space, you could do more social distance, you could have better air quality, and also to bring in, you know, reserves of ex-teachers and the like that could actually, you know, step in for staff that often were sick.
I suppose what I felt was that we had, you know, we had the fantastic Nightingale endeavour for health, furlough in terms of employment, but actually for schools we failed quite miserably, we weren't very creative, we weren't ambitious, and we didn't have the recovery -- you know, the recovery programmes that were put forward weren't backed, they were turned down. So it was as if children were very much at the back of the queue, coming second, and always being overlooked when it came to an important decision.

Page 50:

One thing that I did was -- and others too -- constantly asked the Prime Minister to do a briefing in the evenings for children, especially for children. They did it in many countries. And it was really important for children to know that they weren't alone and that this time -- you know, people were thinking of them. It nearly got there several times, but it never did.

Page 52:

In relation to the next theme, government decisions and consultation, a theme which many respondents commented upon, Save the Children stated that their core hypothesis is that children's rights and wellbeing were not considered as a priority by decision-makers in UK Government and that this has been the case for many years, and they say that this can be evidenced both through the lack of specific approaches such as children's rights assessments and policy developments and the absence of analysis of impacts on children in the key documents which officials prepare for ministerial decision-making.

Page 53:

The Children's Rights Alliance for England comment upon the invisibility of children in decision-making and that this was a long-standing problem which is not and was not specific to the current UK Government, something which was, as I said before, long-standing.

 

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Also on day 4 (last Friday), the General Secretary for the Federation of Ethnic Minority Healthcare OrganisationsL

Concerns about PPE, that frontline staff from minorities werent listened to when they voiced concerns, that there was a lack of data, that getting retired staff to come back to work to help was placing vulnerable people at risk from the virus, that a legal obligation for risk assesssments to be undertaken wasnt done.

And a few quotes I grabbed:

Page 104:

So something like vitamin D -- and, you know, science tries to obfuscate and say actually racism isn't involved here and there should be another biological reason, so -- it's now been debunked, but it kind of masks and -- it's something that's very uneasy for us to talk about, that it shows that actually -- we kind of scramble around for: there must be another reason, it can't be because of racism that there is difference in outcomes here.

Pages 106-107:

You know, most of the PPE that was procured fit a certain type, and it was mostly industrial, so for people of different race, different genders, some with religious, you know, head scarfs and other ornaments, it was difficult to find the right PPE. And this gave us a sense of a lack of, again, a belief of what we were saying, that the system can pick up signals and noise and disruption in other areas, but when there's noise and disruption of black and Asian ethnic minority workers, it's not heard and it's not responded to immediately.

So, you know, we're not immediately clear whether it was, you know, a buy problem or a distribution problem, but it certainly was a problem on the wards where, when we did say these things, and when systemically it's happening across the NHS system, across the country, it's not being immediately believed, it's not being immediately responded to, it creates that understanding or perception that there is an institutional systemic response for one set of problems, and for our members, black and Asian ethnic minority workers, there is a different systemic response that's quick, that's not proportionate to the scale of the problem.

Q: I mean, what you're describing, Professor Nazroo was here yesterday, he would term that structural racism. Is that how you define it?
A: If it quacks like a duck and it walks like a duck, it's a duck.

Page 108:

This is evidence submitted to the Women and Equalities Committee:
"... 64% of BAME doctors reported feeling pressured to work in settings with inadequate PPE compared with 33% of white doctors."
I'm just looking at the footnote there. And that seems to have been dated July 2020.

Pages 109-110:

Q: On a related matter, this is a couple of paragraphs later in your report, not PPE, but oximeters, so I think I'm right in saying those small gadgets that you put your fingers into which measure both your pulse but also oxygen levels in the blood, so they are a diagnostic tool to see whether people have Covid; is that right?
A: That's right.
Q: They were used. Tell us, I think the experience was that they -- well, tell us what the problem with the oximeter was.
A: The problem is that they work on infrared technology, which -- there's a wider industrial systemic problem, which is that the tests and trials used to verify them were mostly done with white skin trial participants, so the technology doesn't work as well on people with darker skin, because it relies on infrared bouncing back from pigmentation. And a feeling that, again, when we raise these problems, and we have members who worked with the Department of Health, with the medical health regulator, MHRA, it wasn't quite believed. We had an institution that was set up for ourselves, the NHS Race and Health Observatory, which did research into this. And again, there's an issue with a medical device, we know it doesn't work on a certain population, and the response from the system, from the ecosystem, feels slow, feels sluggish, feels like it's not believed. And it went around in that MHRA cycle for a while, and that's what our members feel and see.

 

[elbows]

An expert who prepared a report for the inquiry titled "Structural Inequalities and Gender":

Pages 120-121:

Q: Now, a key and critical question that might be asked by some or posed by some is that, with the exception of Hurricane Katrina in the United States, these are all less affluent countries in the global south. So, essentially, why are they relevant to the UK, a western and industrialised country?
A: Well, because the thing that we see across all these outbreaks, whether they be in Brazil or in Sierra Leone or in Yemen is the same trends. It's the same ways in which women are impacted by these crisis events. It's always about unpaid care, it's always economic impacts and women losing work or financial security. It's always challenging access to healthcare for women and particularly sexual productive health needs. So it's the same trends globally, so, we know the concern is: why would it be any different here in the UK?

Q: Thank you. And is that a view that you've heard expressed at all in the UK, or by government?
A: It was something I heard expressed early on in the course of 2020, yes, I heard comments around the differences here in the UK to that of Liberia, for example.
Q: In what context was that?
A: In a meeting with officials working in government.
Q: What area of government?
A: In Cabinet Office.
Q: In the Cabinet Office?
A: Yeah.
Q: What was the sentiment that was expressed?
A: The sentiment was it was London, it wasn't Liberia, and that there wouldn't be the same impacts here for women.

Pages 121-122:

Q: I now want to turn, if I may, to a separate topic, which is that in relation to public funding cuts since 2010 that you raise in your report, and you explain in relation to that that significant cuts had been made to healthcare, by 2015 over a billion, 6.3 billion from
social care, 13 billion from education, and indeed, by 2020, £37 billion had been cut from welfare payments.
Can you, in headline summary form, for us, please help the Inquiry with how that specifically, in your view, exacerbates gender inequality?
A: Sure. So the two headline messages from the austerity-related cuts in the UK for women are this. The first one being that women are more likely to use public services, they're more likely to need interaction, whether that's through benefit support, whether that's through healthcare services, whether that's through a range of different ways that we see women engaging with these services, so they're more likely to be users, but we also know that women are disproportionate employed in the public sector as well, as healthcare workers in the education sector, for example.

And loads more stuff worthy of quoting that I cannot quote now. So I will try to link to that full report when I get a chance.

 

[elbows]

The head of public affairs and partnerships at Solace Women's Aid:

Page 150-151:

Q: I'm just going to ask you just to pause there for one moment, and just pick up on the interactions with Solace and the advice line and the patterns that you saw. You just explained that in March 2020 you saw a 117% increase. Is that coinciding, essentially, with the decision to lock down, the announcement to lock down?
A: So I think some of that came before as well, because women were fearful that a lockdown would happen.
I think when they saw what was happening in other countries, many women thought "I need to get out, I cannot spend that period, if the UK goes into lockdown, in this relationship, in this house", essentially, and in danger for them and their children. So I think that led to an uptick actually before announcements were made.

Q: And then you describe a subsequent period where calls dropped and decreased, and eerily quiet. When was that?
A: That was late March and early April, is my understanding.
Q: Then in April you describe within your statement a second increase, in April to May, and what did you connect that to?
A: I think that was when for some women it was because it became too much living in that household, living in danger for them and their children. For others I think it was when there was starting to be an understanding that we may leave lockdown and people were getting that chance, that opportunity to get in contact with services.

Page 154:

Q: You do refer in your statement to the national domestic abuse helpline and seeing a 65% increase in April and June compared to January and March of 2020; is that right?
A: Yes.
Q: Similarly from Victim Support, in May 2020 they were seeing reported rapes as being 23% higher than that in early of 2020?
A: Yes.

Page 155:

A: So we saw that for every space we had, we'd have four referrals, and actually in April 2020 all 23 of our refuges were full at one point.
Q: And you explain in paragraph 49 of your report that Solace then opened a 70-bed emergency accommodation project on 12 May of 2020. Was that in consequence of that uptick in terms of demand?
Yes, we were seeing that there were so few options for women to go to when they were seeking to flee, and I think it's quite important to say that it took less than a month for that 70-bed accommodation project to be filled and, of the spaces for women with no recourse to public funds, the 20 spaces we had, they filled up within a week.

Page 158:

Q: At paragraph 208 you note there has also been an increase in domestic homicides during the pandemic; is that right?
A: Yes. Home Office did research into that, and I think in that early window there was research to show that there had been five -- I think five domestic homicides per week compared to two in normal times.
Q: That's at the early stages of the pandemic?
A: Yes, in those first few weeks.

Page 163:

Q: And the government did institute a "You Are Not Alone" campaign from 11 April. What are your views on that?
A: We were pleased when the campaign was launched. Again, I think it was a positive step, but we saw on our own advice line that that wasn't cutting through to all woman who needed our support. We were getting women saying they didn't know they could leave, when they
called us, and we actually had that across all three lockdowns. So the messaging certainly didn't get through to all women. I think that was the same experience for the national helpline as well. We felt that that messaging was too late. It could have been pre-empted. From the messages from the sector and from international comparisons, and our understanding of pandemics and emergencies more generally, that this was a message that needed to be there from the beginning.

Page 166-167:

Q: In your view, were women and children facing domestic abuse adequately considered by the government with regard to its Covid-19 response?
A: Our view is that they were not considered and, when they were, it was too little and a bit too late for women and children.
Q: And specifically where do you see those failings?
A: So we are not aware of domestic abuse and wider violence against women and girls being considered in the emergency preparedness that government undertook before the pandemic. It appears that they were slow or -- to react or ignore from international experience of the increase in domestic abuse, or some of the understanding and experience we had from other international emergencies that was referred to by the previous witness. There was a lack of consultation with the sector, and when we were consulted it was quite late, and small groups. It didn't look at the impact on marginalised women, so that's black and minoritised women, older women, disabled women.

 

[elbows]

The TUC on that same days session...

Lots of general and specific concerns about workplace safety and other issues like sick pay, including on page 67:

We'd called for a bus safety summit very early in the pandemic; that's not a call that was heeded, and we know about the devastating impact on workers in that area of the sector.

We called for areas which could have given a greater confidence in the return to work, so for example the publication of risk assessments and the need for workers to have a clear sense of what their own employer was doing.

We called repeatedly for the need for additional resources for inspection and better enforcement, and of course, as I think we may go on to discuss, the need for better support for self-isolation, the need for better financial support, was something we repeatedly raised and we did not think we had an adequate response to.

Pages 78-79:

Q: I'm just going to ask you a few questions about the second of those reports, Dying on the Job - Racism and risk at work, which was published by the TUC in July 2020. For those purposes, can we go, please, to paragraph 265 of the witness statement, a page or two on. You describe there, Ms Bell, a call for evidence in June 2020; is that right?
A: That's right.
Q: Which was responded to, you say, by 1,200 or more workers. What were the key conclusions drawn, the key pieces of evidence given in that report which are set out there?
A: Well, I think this was clearly showing the disproportionate impact on BME workers. So this was a call for evidence, so it was self-reported, but one in five of those responded said they had been treated unfairly at work because of their ethnicity during the pandemic. Around one in six said they'd been put at more risk of exposure to coronavirus because of their ethnic background. And they described things like being forced to do frontline work that white colleagues had refused to do. They also talked about being denied access to proper personal protective equipment, refused risk assessments, and singled out to do high-risk work.

Pages 81-82:

Q: Sticking with women generally, I'd like to go on, please, to paragraph 280 of your statement. You list there some very striking statistics about women in the workforce during the pandemic, which are worth noting. You say:
"Of the 3,200,000 workers at highest risk of exposure to COVID-19, 77% are women." 77% of healthcare workers were women, 83% of the social care workforce, and 70% of those working in education. "Mothers are more likely to be key workers than fathers or non-parents, 39% of working mothers were key workers before this crisis began, compared to 27% of the working population as a whole."
As I say, striking statistics. Were those issues that the TUC campaigned on during the pandemic?
That's right. The overrepresentation of women in many key worker sectors was something we were raising, and therefore the disproportionate risk on them. And also pulling out issues like the lack of suitable PPE for women, so Prospect members, for example, reporting that even before the Covid Inquiry that women were being -- sorry, the Covid pandemic, the lockdown, reporting that women were being overlooked when it came to appropriate PPE.

Pages 83-84:

Q: One other theme that comes through from this passage and also from some others in your statement is a feelingamongst care workers and NHS workers of something close to resentment at the public clapping during the pandemic. Can you tell us a little about that?
A: I think it does come through, and I think "resentment" is not quite the right word --
Q: Tell me --
A: -- but perhaps a feeling that it didn't -- that people could not understand the scale of what they were experiencing.
LADY HALLETT: They were underappreciated.
A: That they were underappreciated, underappreciated the scale of what they were experiencing, the lack of clarity or guidance that they needed in order to do
their jobs, and of course their long-running concerns before the pandemic, which we have talked about, about their pay and conditions not being -- claps, you know, claps don't pay the bills, as many workers have been chanting this year.

 

[elbows]

Going back to the day before that, day 3, to see if there is anything I can 'quickly' pluck from the transcript. https://covid19.public-inquiry.uk/w...3250/2023-10-05-Module-2-Day-3-Transcript.pdf

Chair of the British Medical Associations UK council:

Pages 90-92:

A: Yes, because there was a shortage of PPE, the very high-risk areas, like intensive care units, were using respiratory protection throughout the pandemic, but once you got beyond an intensive care unit, with people who were Covid positive, the amount and degree of PPE very rapidly tailed off. So, for example, people were either treating patients with no masks or with fluid-resistant surgical masks, which don't protect from an airborne virus.
Q: Was another area of general concern to the BMA the disproportionate impact on ethnic minority communities?
A: Yes, there were quite early data from the intensive care community showing a disproportionate number of intensive care admissions from black, Asian and minority ethnic groups. Alarmingly, the first ten doctors who died of Covid were all in that black and Asian and minority ethnic group, and that was spotted very quickly by a number of organisations, including BAPIO, and the BMA, and the BMA then wrote immediately to raise concerns.

Q: So were there three areas, in fact, touching upon the issue of your ethnic minorities: one, the disproportionate impact of the virus on them; two, the disproportionate impact of the virus on members of your association who were from ethnic minorities; and, three, was there then the issue of the efficacy or suitability of particular types of PPE for those members of your organisation who were drawn from ethnic minorities?
A: That is true, because PPE needs to be particularly well fit tested, and it doesn't suit people with beards, for example, for religious purposes. But people fromethnic minorities are less likely to stick up and speak up when there is insufficient PPE, and they -- we found that they were much less likely to have had an adequate risk assessment.
By the end of the first wave, two out of three doctors still hadn't felt that they'd been adequately risk assessed.

Pages 93-94:

Q: Now, as at that time, mid to late March, to what extent did the BMA have a view on the particularity, the specifics of what the government was proposing by way of social distancing and then ultimately, from 23 March, lockdown? Were you focusing in your engagement with the government upon the impact of whatever it is the government might then have been proposing, or were you focusing on the efficacy of whatever was being proposed, would it work?
A: Well, the biggest issue really started one step back from that, was our lack of understanding as to why the government was apparently abandoning basic public health protection measures. Our local public health teams, our local public health doctors were prepared for a pandemic, this is their bread and butter subject, and we seemed to have abandoned that first principle of control of an infectious outbreak by trying to control and contain through testing and isolating and making sure that you can support people to do that.

Page 97:

To what extent did the BMA become aware that there was a very distinct limit on the physical number of tests, testing kits available?
Well, that happened very quickly, because we were relying on the availability of the PCR tests to keep
people in work. In the absence of the PCR tests, we were having to isolate for 14 days, isolate if we were contacts. We were already short of staff and we ended up in that first wave with huge numbers of staff not
being in work when they potentially could have been if there were tests to test both them and the patients around. And of course the consequence of not having sufficient tests in those early days were that we were admitting patients to unsuitable areas with patients who hadn't got Covid. So the chance of passing Covid around a hospital was very high.

Page 98-99:

As the clock turned through those dark days of the end of March, to what extent did the BMA seek to engage with the government on the primary decisions to, firstly, throughout mid-March, impose social restrictions, and then, on 23 March, announce the lockdown?
Well, we had been advocating for strengthened measures, these non-pharmaceutical interventions, as soon as contact tracing was abandoned. That 11-day delay until the lockdown, and given that there was already a plan in place, just seemed to be increasing the number of infections unnecessarily. And that had a huge consequence not only to the public but to the health service as well, because the number of admissions soared during that time, the number of people who caught Covid and had been affected by it soared during that time, and we did feed back both to government and then publicly in the media that we thought that this was an unnecessary delay.

Q: Can we just unpick some aspects of that answer. So on 12 March the government announced that there would no longer be testing in the community and such PCR test as there was would be kept for healthcare workers.
By that time, the First Few 100 dataset, the analysis of index cases and the pursuit of their contacts and the isolation of their contacts, had given up the ghost, it stopped at 415?
A: They'd lost control.
Q: They lost control. So are you saying that thereafter, from 12 March to the lockdown day of 23 March, there was in practice no way of assessing the degree of spread of the infections through the community at large?
A: That's what it seemed like to our members.
Q: And if you don't know how the virus is spreading, other than by way of estimate or modelling, what means of control have you got to suppress it?
A: Very little. We were seeing the results of that actually on the frontline.

 

[elbows]

More from that same witness:

Pages 101-103:

Q: In the summer of 2020, was there a general concern being expressed that, because the virus -- the levels of virus in the community had not been brought down low enough, too great a degree of relaxation in restrictions, or complete freedom, would allow it to unspring, uncoil itself like a spring, back out into the community violently?
A: Yeah, I'm advised by my public health colleagues that you need a rate of around 10 per 100,000, which is around 100,000 cases per day, and the UK was above that.
So, you know, the data were suggesting that it was unsafe to ease lockdowns at that point. We were advocating mandatory use of face protection, face masks for the public. We were advocating later for a higher degree of protection from vulnerable people, as the shielding came out of play.

Q: Just finally before lunch, then, and just identifying certain aspects of the face mask debate, the government did impose a mandatory face covering order, firstly in relation to public transport and then latterly shops and supermarkets, but relatively speaking you were calling for mandatory face masks across the population at an earlier time?
A: Yes, we were. It didn't make sense to us that there would be -- and if you're going to ask the public to wear face masks, then why not do it all in one go rather than this phased approach, which seemed to us to be sustaining the transmission unnecessarily.

Q: Did you at the same time call for ways in which the government could ameliorate, make better, the position of people who were subject to restrictions? There were some people, of course, a lot of people, who were subject to continuing shielding restrictions, and during the lockdowns themselves, of course, people who required better financial support, help with combatting the effects of isolation, and so on. At the top of page 36, for all these particular issues, did you go into bat against the government?
A: Yes, we did. The best phrase that I've heard about that situation was that we were all in the same storm, but not in the same boat. There were clear discrepancies about how the pandemic was affecting different parts of our society, the poorest, the homeless, those who were already vulnerable. And that stayed with us. So when the country came out of lockdown, in inverted commas, right at the end in 2022, we've still got a situation in which very vulnerable people feel very exposed and are still hiding away from society.

Pages 103-104:

Q: Professor Banfield, at paragraph 145 you say this:
"While not a specific [non-pharmaceutical intervention], the BMA contends that a key failure of the Government was, and continues to be, the failure to properly acknowledge (and at an early enough stage), that Covid-19 was spread by aerosol transmission and to adapt their public messaging, guidance to health services or the focus of their NPIs appropriately."
Was that because there was an issue in the very early days as to whether or not Covid was transmitted by droplet or aerosol or both, and when it became apparent that it could be spread by both vectors, or both forms of transmission, the government didn't sufficiently tailor its messaging?
A: That's true in some ways. We have always advocated a precautionary approach to public health measures, and it was known that similar coronaviruses are transmitted by aerosol, you know, airborne spread rather than droplets, so it seemed sensible from a professional point of view to consider that possibility. There became more emerging evidence across that summer, and it became unequivocal, and at the point at which it became unequivocal, there were temporary changes to the advice from Public Health England that then got reversed after the vaccination programme came into play.

Page 105-106:

Q: ...you met with some success in relation to calling for further work to be done on the impact of the pandemic on people from ethnic minority backgrounds, because in April of 2020 the government announced that they would be conducting a review led by Public Health England?
A: Yes.
Q: Was that the disparity review that PHE carried out?
A: It was indeed, yes.
Q: You say there that you did have some concerns about the findings, though. What were those concerns?
A: Well, we knew that a large number of stakeholders had been interviewed, and there seemed to be a large amount of evidence missing from the original report. Furthermore, the report didn't have any recommendations in it, so we were suspicious, and later had it confirmed to us, that pieces had been removed. At that point we wrote and asked for the report to be reissued.
Q: And was it?
A: It was modified in that the stakeholder engagement was then published later, and there were then recommendations.
Q: So it wasn't, though, that their conclusions were for some unknown reason omitted, it was that the report had the ability to be able to cite passages of material submitted by stakeholders and a lot of the material or some of the material submitted by stakeholders wasn't reflected on the face of the final report?
A: As put to me, people felt hugely let down and as if it had been watered down.

 

[elbows]

Same witness, continued...

Pages 107-108:

Q: ...there's another important point. You raise the issue of what you say is the lack of independent public health expertise informing and supporting the public health response to the pandemic.
Now, obviously a large number of members of the BMA work in the public health field. Was a general concern raised that the government was not receiving sufficient advice from public health experts, experts perhaps in pandemic management or the delivery of appropriate healthcare facilities at local level, as opposed to the epidemiological aspect of this affair?
A: Our public health members who have expertise in this field felt deeply disrespected and that their views and expertise was being ignored. It was felt that decisions were being made at governmental level and were not seeking the expert views and opinions of people on the frontline with local and contemporary public health expertise.
It's difficult if you are in a government environment to stand up and openly criticise a government, and our public health colleagues are quite good at saying when something isn't right, and they felt that that ability to criticise or push back or challenge was missing.

And then some stuff about behavioural science where the chair ended up stepping in because they thought the use of the word political wasnt fair!

Pages 108-109:

Q: At the same time, was concern raised about the over-reliance on behavioural expertise?
A: It was. There was a lot of concern about how the necessary measures for public health protection would be received by the public, whether the public would agree to lockdown and, if so, for how long. And, you know, as it turned out, the public responded very well, but that seemed to drive the narrative in, for example, mask wearing. So instead of bringing it in in one go, they staggered it. It seemed to be based on what was a political imperative to engage with the public rather than a public health narrative. The public health narrative seemed lacking, actually all the way across the pandemic.

LADY HALLETT: Is that fair, Professor? Because if you do have concerns about how the public will respond, it's not necessarily a political imperative so much as an imperative trying to ensure people will comply with the guidance or advice. Is that really fair to accuse it of being a political imperative?
A: I think some of the messaging became confused --
LADY HALLETT: I'm not denying that. What I'm saying is you called it a political imperative when I'm just saying maybe it was a "We need to keep the public onside so they will comply" imperative.
A: I think I'm suggesting that there were economic and other factors that lay outside public health necessities in deciding what the messaging to the public was.
MR KEITH: So not political, but just not public health --
A: Political with a small p.

 

[elbows]

The BMA bloke was then questioned by the legal representative for the Federation of Ethnic Minority Healthcare Organisations.

A few quotes from that:

Pages 114-115:

Q: So the first question that I've got for you is: we've looked at the experience of black, Asian and minority ethnic healthcare workers in the profession; I would be interested to know what insights that you have and whether you can elaborate on what you think the key concerns posed were relating to those healthcare workers in terms of the virus and their vulnerabilities?
A: There were a number of issues that arose going into the pandemic. Firstly, the NHS is acknowledged to be institutionally racist; there are discrepancies both in the way that staff are treated and the experiences that staff have at the NHS as well as patients. So, taking the disproportionate physical effect on them, the ability to protect staff during the pandemic was affected by the biases and discrimination. People from an ethnic background are less likely to seek out and be upheld with their risk assessments, they are less likely to be forthright about saying, "I need to have appropriate respiratory protective equipment", they are more likely to have been posted to the frontline and exposed to high-risk cases. And the recognition that that was the case emerged across the pandemic and has been recognised by the NHS, and there are very active steps being put to correct that, both driven by us and by NHS England.
Q: And so, if I can just follow up on that, so to be absolutely crystal clear, these aren't imagined concerns, these are very real concerns, are they?
A: Yes, they are, and they have been found in multiple reports.

Pages 116-117:

Q: Next, what tangible steps could government institutions take to tackle some of those healthcare disparities that you've told us about amongst ethnic minority communities, particularly in the context of the pandemic?
A: Well, I mean, there's a greater recognition of the need for cultural competency. You know, we went into this pandemic with one set of health messages and made no attempt or little attempt to adapt those for different recipients. So it took a long time, for example, for videos to be -- and messaging to be worked up with the BBC World Service, for example, into different languages and to become culturally competent to the communities that were actually subjected to huge discrepancy and bias.

Q: Sorry, just to be clear, so you're saying, if I can paraphrase, it was only being looked at through one lens, a white lens?
A: I'm going to say that it was looking, to start off with, as that as the default.
Q: Yes.
A: I would say that it became very apparent very quickly that that was the wrong lens, and I think that enormous efforts have gone -- been made since then to recognise and correct that. And that's part of our longer term wish, to make sure that inequalities, both inside the health service and in our communities, are narrowed and resolved. Because, you know, this country cannot go on like this.

And a final quote from the end of his session when he was questioned by someone representing a Long Covid group:

Q: You've made representations to government and during the pandemic, because of the impact of long Covid and the prevalence of that syndrome, you in fact made arguments to the government as to why there should be delay in the lifting of restrictions because the greater incidence of the virus would lead to an increased number in long Covid cases?
A: Yes. I mean, we've had feedback from over 600 doctors with long Covid, and their stories are horrible. It's disrupted their lives, it's stopped their careers. And there's still a lack of acknowledgement that this could and is most likely to have been gained at work.

 

[elbows]

The next witness that day was an expert who had already been called earlier in the day because he had done a special report on ethnic inequalities in the areas or the fields of health, society and the economy, and was called back because he also did a report for them titled "Inequality, Later Life and Ageism".

Its another one of those things that I dont think I can do justice to by quoting from the oral evidence. So I'll just quote a few of the statistics that got mentioned, and hope to link to the entire report later.

Page 131 of the transcript:

ONS figures between March 2020 and June 2023: that of the deaths classified as being due to Covid-19, 59.6% of them occurred in the age group of 80 and over, 22.4% the cohort between 70 and 79, at 10.6% 60 to 69, and 6.6% in the age group 40 to 59, with less than 1% of those deaths occurring for people younger than 40.

There was also mention of a report written some years before the pandemic, where one of the authors was Jonathan Van-Tam. Here are some bits they chose to quote from it on pages 146-147 of the transcript:

"Persons residing in LTCFs [long-term care facilities] present a population very susceptible to the acquisition and spread of infectious diseases and for whom the consequences of infection may be serious. Nursing home residents are at greatest risk due to their overall frailty, close quarter living arrangements, shared caregivers, and opportunities for introduction of healthcare associated infections and the spread of pathogens to other facilities through resident transfers and the movement of staff and visitors in and out of the home."

"Outbreaks of influenza caused by both influenza A and B viruses are well documented in LTCFs, and may be explosive, with high mortality, highlighting the need for early recognition and prompt initiation of control measures."

"Transmission of influenza from healthcare workers ... to hospital patients, including those in geriatric facilities, has been well documented using epidemiological linkage, nucleotide sequence analysis and contact tracking data and case reports of outbreaks of influenza-like illness in care facilities indicate that staff can transmit the virus to residents."

"The observed variability ..."
That's in these test results, of healthcare workers. "... might be explained by [healthcare workers]
being at higher risk of asymptomatic or subclinical infection, indicating that [healthcare workers] may act as an infective pool to transmit influenza to frail elderly people."

"Although the role of asymptomatic people and those with only mild symptoms in spreading influenza is uncertain, [healthcare workers] often continue to work despite having symptoms and may act as a source of infection to those in their care. Nursing home aides in particular have been shown in one Swedish study to be the occupational group at significantly greatest risk of continuing to work despite the feeling that, in the light of their perceived state of health, they should have taken sick leave. However, in reality the employment status of many LTCF staff is often precarious and taking unpaid sick leave may result in adverse economic consequences."

Q: One might think -- thank you very much -- Professor, that in that article in 2017 Professor Van-Tam was flagging certain risks, risks that in fact, as we shall hear, transpired with terrible results, very clearly?
A: I think the paper flagged those risks very clearly, yes.

 

[elbows]

Representative for bereaved families for justice Cymru asked him some questions including:

Pages 161-162:

Q: At paragraph 77 of your report, you say that many hospitals used some form of triage to restrict intensive care for those aged 60 and over, modelled on a disseminated but not implemented NHS Covid-19 decision support tool. It's right, isn't it, that the decision support tool was a points-based system, using a combination of four constituent scores across the domains of age, gender, level of frailty and medical conditions, that then subsequently recommended patients into particular treatment pathways?
A: That's correct, though, as you said, this decision support tool was never implemented.
Q: Yes.
A: Though it may have influenced decision-making.

Q: When assessing levels of frailty, the clinical frailty score, also known as the Rockwood frailty score, is also used as a prognostic indicator; is that right?
A: That's correct.
Q: Do you agree that the blanket use of the decision support tool and the clinical frailty score, insofar as they were used, and other similar tools, are potentially discriminately, and if so why?
A: They are discriminatory, in my view, so long as they restrict entry into care. My opinion is that they are useful tools for identifying those who need care, rather than the opposite.

 

[elbows]

The expert reports that the recent expert witnesses have provided. A few of these witnesses gave oral evidence on day 5 (Monday = today until the clock just struck midnight while I was typing this) so I havent even mentioned them yet, and I'm not sure whether I'll get a chance to quote from their evidence sessions. Depends how much Tuesdays evidence occupies all of my attention.

INQ000280057 - Expert report titled 'Ethnicity, Inequality and Structural Racism' prepared by Professor James Nazroo and Professor Laia Becares, dated 15 September 2023

INQ000280058 - Expert report titled 'Inequality, Later Life and Ageism' by Professor James Nazroo, dated 19 September 2023

INQ000280066 - Expert report titled 'Structural Inequalities and Gender' by Dr Clare Wenham. Dated 22 September 2023

INQ000280060 - Expert report titled 'Child health inequalities' by Professor David Taylor-Robinson. dated 21 September 2023

INQ000280067 - Expert report titled 'Structural Inequalities and Disability' by Professor Nick Watson and Professor Tom Shakespeare. Dated 21 September 2023

INQ000280059 - Expert report titled 'Pre-existing inequalities experienced by LGBTQ+ groups' by Professor Laia Becares. Dated 13 September 2023

INQ000269372 - Expert report of Professor Ailsa Henderson, titled 'Devolution and the UK's Response to Covid-19'. Dated 07 September 2023

And the 2017 article that Van-Tam co-authored: INQ000269388 - Article published on Wiley titled 'Influenza in long-term care facilities', dated 27/06/2017

I havent had time to read any of these reports myself yet. I had a similar problem in module 1, spent so much time with the daily evidence sessions that I had no time left to read the written evidence in full.

 

[elbows]

Yesterdays evidence relating to disabilities and devolution is indeed best served by reading the expert reports I already linked to.

The devolved stuff is especially difficult to quote from because it oscillates between incredibly dull, technical, legal, constitutional stuff and a few occasional moments where we get soap opera stuff relating to individuals and their attitudes.

When it comes to the latter, I will just include this image they provided of communication between Cummings and Johnson (we dont get to see any of Johnsons replies in this version). We already heard a chunk of this stuff in opening statements but this version includes more sentences and came up in the devolution evidence because Cummings mentioned DAs = devolved administrations....

 

[elbows]

One of todays witnesses was former (gone well before the pandemic) cabinet secretary Gus O'Donnell, so the BBC bothered to report on the session.

A lot of his evidence was dealing with human relations and resembled a rather dull episode of Yes Minister, so there are only one or two things beyond what the BBC article already mentions that I weill bother to quote when I get round to todays transcript.

Partygate revelations destroyed trust in government, inquiry told

Ex-cabinet secretary says 'under no circumstances' should lockdown parties have taken place.

www.bbc.co.uk

 

[elbows]

So, yesterdays proceedings, starting with the aforementioned Gus O'Donnell, who ceased to be Cabinet Secretary back in 2011.

Day 6 transcript: https://covid19.public-inquiry.uk/w...1531/2023-10-10-Module-2-Day-6-Transcript.pdf

As I said I'm skipping most of it due to that media report and the generalities much of it involved. Just a few quotes:

Pages 14-15:

Q: It is now well known that Sir Patrick Vallance, then the Government's Chief Scientific Adviser, kept a set of diaries or evening notes in which he recorded his contemporaneous views on the workings of government during the crisis. In those dairies, in fact on 11 November 2020, he says this of your successor, Cabinet Secretary, Simon Case:
"Simon Case says No 10 at war with itself - a Carrie faction (with Gove) & another with SPADs ..."
What are SPADs?
A: Special advisers. Political appointees, not civil servants.

Q: "PM caught in the middle. He has spoken to all his predecessors as [Cabinet Secretary] & no one has seen anything like it."
Lord O'Donnell, were you one of the predecessors to whom he spoke?
A: Most certainly I was, yes. And like I say, you know, I look back on this and think I was blessed, I actually had a relatively easy time. All of the prime ministers I worked with, I could say I think there was that sense of mutual trust and respect, and ability to get prime ministers to focus on the decisions they needed to make and the information and evidence they needed. That was clearly, from the evidence you're seeing -- obviously I wasn't anywhere near this at the time, but from the evidence you've got from other people, that was clearly an issue. And once that's an issue, you need -- the reason that the Cabinet Secretary, Simon Case, would have been talking to Patrick Vallance about this is they need to understand how to operate in a way in which -- the top is not functioning as well as you would like it to, and when that's happening, you obviously need to think about: how do we ensure that the best decisions are made for the country when it's not working as well as one would like?
And that means that sometimes you have to, you know, be clear with the key officials, like Patrick Vallance, Chris Whitty, that there are problems with these relationships, and therefore things may not happen as quickly as you would like.

The answer to the following was a load of wind so I'm not going to quote it, but I think the framing of the question was of note:

Pages 15-16:

Q: But the outcome, the ultimate outcome of a failure to take a grip on factional infighting or loss of confidence in important individuals or breakdown in the relationships of trust between these various departments and the various individuals will be, won't it, a degradation in the decision-making? No government sensibly constituted can respond properly to a crisis and make these momentous decisions if it's at war with itself and if its various moving parts are, bluntly, dysfunctional?

 

[elbows]

Pages 26-27:

Q: One of Sir Patrick Vallance's diary entries from December 2020 says this, that the permanent secretary had become annoyed that the Chief Medical Officer and the Chief Scientific Adviser had told the Prime Minister about a new variant, and he says:
"Sounds familiar. Really we had no choice and he needs to know. The civil service reflex to slowly manage politicians is really awful."
Does it follow that if there is a lack of ministerial experience, then any level of dysfunctionality in the civil service, in Number 10 or the Cabinet Office, in terms of informing ministers, informing the Prime Minister, providing them with the right information, the right evidence, will have an extreme, perhaps a disproportionate impact on the ability of those ministers to make proper decisions? Without the experience and without the proper flow of information and advice from the civil service, those ministers will be, frankly, at sea?

A: So, yes, they need the proper advice, but this comes back to my point about working as well as possible with the ministers you've got. So if you know you've got a minister that is liable to, on being told there's a new variant, to immediately jump to a policy conclusion which you think may be wildly mistaken, then it actually makes sense to pause for a second and say: okay, so if we say there's this new variant and it's much more powerful, we really need to be able to answer the Prime Minister's question afterwards, which is, "So what should I do about that?"
So you might want to hold back and say: let's do some analysis first, let's make sure that we've considered various policy options and put before the Prime Minister these various things. Because otherwise there's a chance the Prime Minister will come to a snap decision when told about it and will then talk to somebody else who will say, "Yes, but there's a case for doing the opposite". So you really need to work with what you've got, in terms of ministers, and you need to understand how the machine can help those ministers make the right decisions. Which may well often mean that you pause for a second before you actually give them some new piece of data.

Page 53-54:

Q: As far as you are able to say, did the government ever publicly debate, put to the country what its strategy was in relation to what level of loss of life it would deem is acceptable? So in this debate about suppression, that's to say complete control or mitigation, there is this terrible issue of herd immunity: if you are merely mitigating or managing a virus, by implication it requires the virus to spread through or to continue to spread through parts ofthe population that you're unable to hermetically seal.
Did the government, in your view, make plain the limits of and the nature of this strategic debate, this strategic issue?

A: I think they were very nervous to do this, and I think they were very nervous because if you take the implication of your statement to its logical conclusion, it gets you into a discussion of: what's the value of life? And we know that governments routinely make decisions based on a particular evaluation. You know, the cost-benefit analysis for roads dating back 30 years has done this.
Q: And medicine, medicinal products --
A: NICE, for example, where NICE works out whether -- sorry, National Institute for Clinical Excellence works out whether a new drug can be made available, you're doing these things. Politicians very rarely like to have that debate, because it's a very cold-hearted debate to say actually it's not worth saving this life because it costs too much money.
So it is difficult for them, I accept that, but actually implicitly they are making those decisions, so it will be good if, even implicitly, there were understanding that behind this there is a consistent application of their judgement as to what the trade-offs are.

Pages 56-57:

LADY HALLETT: How are you ever going to get that -- realistically, how are you ever going to get a political party to talk to the public about possibly allowing a disease to run riot through care homes, killing people in large numbers?
I mean, yes, you could have a rational debate of the kind you've talked about, but is that really going to be something a political party is going to want to engage in with the public, and possibly hostile sections of the media?
A: That's a very good question. I mean, there's nothing to stop the public inferring what the implied value of life is. And indeed, you know, some people did that. So it's not like this is hiding away.
I think part of political leadership is getting the public to face up to the fact that there are going to be difficult decisions, that we can't save everybody, therefore we want to put our resources in the places that will save the most people that we can.
Now, the public would get that, and they would understand that, you know, there were limitations on what could be done. But the fact, if there is trust, that you are really trying to do the best, and having laid out in your strategic plan what the best means, then I think you start to build public trust and you can start to have that debate.

Since I only had room to quote certain chunks of that discussion, probably best to view those sections of the transcript if interested in these themes and the way senior civil servants dress this stuff up.

 

[elbows]

The next witness was Sir Ian Diamond, the National Statistician and head of the ONS. Theres a lot of dry technical stuff in this evidence, including how death certificates work and how they adapted to get covid listed as a cause on those certificates. And excess death figures. On some other themes I'll just pick a few snippets that I noted down at the time:

Pages 105-106:

Q: (b), do the death certificates provide the sex of the deceased, enabling you to work out mortality rates between men and women?
A: Yes, they do, and we demonstrate a marked trend that men were more likely, sadly, to have been impacted than women.
Q: And were mortality rates, as we all know very well indeed, highest in the oldest age groups?
A: Very much so. Significantly so. And of course that, given that with old age comes an increasing probability of disability, the two are quite interlinked.
Q: (c), did nine out of ten deaths involving Covid in England occur in a hospital or care home?
A: Yes, they did.

Q: Of course, they could have contracted -- they could have acquired or become infected with Covid either before or during their residency in hospital or a care home?
A: Exactly so, and there was a lot of discussion over the period certainly of the first couple of waves of nosocomial infection.
Q: (d), did the majority of Covid-19 deaths in England occur among disabled people?
A: Yes. And that again, as I indicated, was due to the association between old age and disability.
Q: Was that link between disability and old age and death prevalent or in existence even after accounting for factors such as socio-economic and demographic characteristics and vaccination status?
A: Yes.

Page 108:

Q: Did that age-standardised approach demonstrate that mortality rates were higher amongst groups associated with transport and mobile machine drivers and operatives and elementary administration and service occupations? And we'll come back a little later to describing what those were.
A: Yes.
Q: (f): "Many people ... reported ongoing symptoms after infection, known as Long Covid."
Did your data show the highest rates of self-reported Long Covid amongst adults aged 35 to 69 also amongst women and also those living in more deprived areas and amongst disabled people?
A: Yes.