Transcript of Module 1 Public Hearing on 22 June 2023

(9.59 am)

Lady Hallett: Yes, Mr Keith.

Mr Keith: My Lady, the first witness this morning is Roger Hargreaves, please.

Mr Roger Hargreaves


Questions From Lead Counsel to the Inquiry

Mr Keith: Could you commence, please, by giving the Inquiry your name, please.

Mr Roger Hargreaves: My name is Roger Hargreaves.

Lead Inquiry: Mr Hargreaves, thank you for your assistance in this Inquiry, and for the provision of the multiple witness statements which you’ve provided. I think all of them are known as corporate statements because you have been good enough to make enquiries on behalf of the governmental department in which you work to set out for the Inquiry much of the history and the chronology of Britain’s approach to preparedness. So thank you for that.

Have you provided three witness statements? We won’t go to them all in detail. Each one has been signed by you, together with a declaration as to the statement of truth.

My Lady, may all those be published?

Lady Hallett: Certainly.

Mr Keith: And they’re dated 1 February 2023, 28 April 2023 and 26 May 2023.

Please whilst you give evidence, Mr Hargreaves, would you keep your voice up, so that we may hear what you have to say, of course, and that your account is recorded for the stenographer. If I ask you a question which is not clear, don’t hesitate to ask me to repeat it. We may get to the break with your evidence, in which case there will be a break mid-morning.

I’d like to commence, if I may, about asking you some questions about your role.

You are currently, are you not, the director of the COBR, the Cabinet Office Briefing Rooms, unit, which is a directorate within the Cabinet Office?

Mr Roger Hargreaves: Yes, that’s correct.

Lead Inquiry: Is that a role that you’ve held, in fact, since July of last year, 2022?

Mr Roger Hargreaves: Yes.

Lead Inquiry: Before that, were you the director of the Civil Contingencies Secretariat, of which we’ve heard much, and was that a post that you had held since October 2020?

Mr Roger Hargreaves: That is correct.

Lead Inquiry: So does it follow that you took over the role of director of the Civil Contingencies Secretariat from Katharine Hammond from whom my Lady heard last week?

Mr Roger Hargreaves: Yes, there was an interregnum of about four months, but yes.

Lead Inquiry: Following your appointment as the director of the Civil Contingencies Secretariat, the secretariat was split, was it not, and it was split into two parts: firstly, and it appears to be a more specific, or a more precise entity, the COBR unit, the Cabinet Office Briefing Rooms unit; and secondly, the Resilience Directorate, which was then a new directorate formed within the Cabinet Office.

In general terms, why – and plainly it was post at least the commencement of the Covid pandemic – was that split effected, why was that done?

Mr Roger Hargreaves: I think the simple headline would be, when you’ve got an organisation that does planning and response, there is always a risk that the response phase draws you in, and therefore people who are engaged in longer-term planning are disrupted to an extent, and that I think had been a bit of the history of the Civil Contingencies Secretariat, that had happened over time – you know, this is the third – my third stint in this bit of the Cabinet Office, and I’d experienced it previously, as kind of – ever since the formation of the organisation. That has some benefits, you can draw staff across and it means the people who are thinking about planning have a real understanding of what actual response feels like, why they’re doing their work, but that separation of responsibility, that sort of specialisation was the rationale behind it.

Lead Inquiry: May we just look for a moment at that in more detail. So your evidence is, is it, that because part of the functions of what was then the Civil Contingencies Secretariat involved the maintenance, the running, the operation of the United Kingdom’s actual crisis management capability, the COBR room, the facilities, the secretariat around it, the provision of advice, the running of our crisis management system, alongside the general policy work and the supervisory work and the co-ordination liaison that was a necessary part of being responsible for the whole civil contingencies structure, it was sensible to split out that crisis management capacity out of the Civil Contingencies Secretariat? Is that correct?

Mr Roger Hargreaves: Yeah, I mean, to be clear, it’s quite a finely balanced decision. There were various reviews over the years that looked at this bit of Cabinet Office and thought about how it should be structured and settled on the side of keeping CCS as a single organisation. You know, there is a reason it endured structurally for 20 years. That’s a very long time in central government terms. The decision to split it apart, I think reflected not just the Covid experience but some of the other recent challenges and there was a view that there just needed to be a tighter focus on crisis management delivery, and there needed to be a view of resilience which was much less about detail and more about strategic resilience of the UK, and that would be better served by separating it out and connecting it a bit better into wider structure making in government.

Lead Inquiry: You say the experience of the Covid-19 pandemic; so that we may be clear about this, was it the experience that the Civil Contingencies Secretariat had of having to address the arrival of the pandemic and the response to the pandemic and of course those terrible days in January to March 2020 that led to an understanding that the system as it was currently formulated was not adequate to deal with the severe demands of such a pandemic? The system hadn’t, as it turned out, been designed or operated in as best a way as possible to be able to deal with managing a pandemic?

Mr Roger Hargreaves: It’s not sort of quite as straightforward as that. The crisis management system in government as, say, existed before the pandemic or, you know, if you go back five years or so, it’s there to try and deliver a crisis response over a relatively short timeframe. Perhaps two weeks, perhaps a month, and then you return back towards normal. That’s very good for a lot of emergencies. But it was also very well developed for civil emergencies, and a little bit different for security emergencies. So essentially the system got pulled out of shape by – by, I don’t know, a terrorist – a serious terrorist incident in 2017, by planning around Brexit, by Covid, by Afghanistan, by Russia/Ukraine, by a whole lot of things.

So when this question was looked at, it wasn’t looked at with specific reference to Covid, but Covid is an interesting example of why there is a strong case for having capabilities that are able to run an enduring response, not just a short-term response, and why upstream factors around prevention, risk reduction, and things like the general fitness of society to deal with crisis, are important.

So it was a rebalancing to try and achieve those things a little more directly.

Lead Inquiry: Your last answer is focused on the resilience side of it. How well did the specific crisis management capacity, that is to say the COBR briefing system, the COBR unit, the COBR room and the secretariat around it, perform in the early days of the Covid pandemic?

Mr Roger Hargreaves: Well, obviously I wasn’t there, and I did think that was a sort of Module 2 matter. I think my one – I suppose –

Lead Inquiry: Mr Hargreaves, I’m so sorry to interrupt. You have been involved in this area of government for many years. You were a prime architect of the Civil Contingencies Act 2004, which is the legal framework for this system. You were the first director of the Civil Contingencies Secretariat to have the unit split underneath you, and you are now director of the COBR unit part. So you know why the unit was split, do you not?

Mr Roger Hargreaves: Yes. I think as I’ve explained there’s a range of factors which contributed to that decision. For some people who contributed to the review that led to the decision, Covid would have been prominent in their decision-making. For many people involved in it, it was actually about other kinds of emergency and the relatively poor performance in relation to international emergencies versus domestic emergencies that caused them to want a more common purpose around crisis management inside the centre of government.

But on your specific question, I mean, I wasn’t there, all I can do is observe from the outside. I think my reflection is consistent with the point I made a moment ago, which is it was a system designed to deal with relatively short-run emergencies. Through January, February, March of 2020 that is what people would have been experiencing, because at that point it was forming up, it wasn’t clear what was happening, and that’s why COBR met repeatedly, it’s why that bit of the Civil Contingencies Secretariat was so extraordinarily busy at that point.

Obviously as the pandemic then took pandemic form, there needed to be a more sustainable governance structure that could carry it through.

Lead Inquiry: Was the COBR structure utilised fully and consistently throughout the currency of the pandemic, or over time in practice was it replaced by other structures or other committees or groups?

Mr Roger Hargreaves: Yes, it was replaced, because, as I said, the COBR function is there to deliver a crisis response to an acute moment. Something spins up, you establish control, it moves back to business as usual. A catastrophic emergency like Covid, and there are other emergencies that fall into this category, require a different kind of management. It’s not necessarily at the absolute pace that you get when you have a crisis, you need something which will keep going week after week, month after month, and that’s not really what the COBR structures are designed for. So, without wishing to kind of go into Module 2 stuff unduly, it was ultimately replaced by a Covid taskforce. There were a few sort of deviations along the way, but that is the model that – I mean, it’s the model essentially that was used in Brexit, it’s the model which we ended up using in Covid, and it’s now part of our standardised approach.

Lead Inquiry: Was it not, in effect, replaced, even during the crisis part of the Covid pandemic, by ministerial implementation groups and also by two committees, XO and XS, which were dealing with the crisis, the catastrophic crisis that was the Covid pandemic?

Mr Roger Hargreaves: XO and XS were Brexit committees.

Lead Inquiry: Yes, and how were they used, Mr Hargreaves, once the pandemic arrived?

Mr Roger Hargreaves: Well, XO and XS, my understanding is that they continued to largely focus on Brexit.

Lead Inquiry: What, in January, February, March of 2020 –

Mr Roger Hargreaves: Yeah, they would have –

Lead Inquiry: – after, in fact, the Trade and Cooperation Agreement was signed and Brexit was over?

Mr Roger Hargreaves: They would have met – right, if they were meeting, they met much less frequently. I mean, this is not – this is not a period about which the detail – you know, I’m not familiar with the detail of this period, and it isn’t something that you explained to me I’d be asked about. So it’s not in the evidence, I wasn’t there, there’s a limit to how much I can explain about the number of meetings of that committee.

What I would say, you know, in relation to your general point, is the early stages of the pandemic were handled as emergencies, national emergencies, are in government, using the COBR structures. They’re designed to deal with short-run emergencies, relatively short-run. What happens at the start of an emergency is essentially you’ve got a kind of moment of decision or a period of decisions: is this something that will flare up and then subside, or is this going to become a much longer term problem? If it’s going to flare up and subside, your assumption is that you will pass it back into business as usual structures. If it’s going to be a very enduring problem, then you need to create new semipermanent structures to deal with it while the crisis endures.

So that’s what we did for Covid. As I say, the journey through – the journey wasn’t a linear journey, we had the ministerial implementation groups, but now our doctrine would be that we would move straight into the sort of Covid taskforce-style structures, and if I think about some of the emergencies we’ve dealt with since the pandemic, I can see those patterns in how we’ve approached them, because some of them have been dealt with by a more enduring structure and some of them have been dealt with just using the Covid mechanism to stand up and stand down. COBR –

Lead Inquiry: Forgive me, the fault is I’m sure entirely my own. I asked you to what extent did the COBR unit function throughout the currency of the Covid pandemic, the crisis, and you said that it became apparent that once the crisis had passed, the initial crisis had passed, the need for COBR had fallen away, because it’s a crisis management capacity.

My question to you was: was COBR in fact started to be put to one side, was there an understanding in fact, in the early days of the Covid pandemic, that as a crisis management facility, it wasn’t sufficient, and therefore during the crisis part of the Covid pandemic alternative structures had to be found and were found – the XS, XO committees, the ministerial implementation groups and so on – because the COBR unit wasn’t functioning as well as it had been expected to do under the extreme demands of the Covid pandemic? That’s the question.

Mr Roger Hargreaves: Yeah. So I think what, I suppose, what I’m trying to explain is the purpose of crisis management structures is to deal with crisis, so the COBR mechanism is designed for that purpose.

The pandemic was a particular kind of national challenge. It had an initial phase of crisis where we were standing up systems to try and understand and prepare to deal with an inbound pandemic, but then it takes the form of a kind of emergency which exists in the space between crisis, where you’re desperately trying to deliver control, and – and the kind of territory of business as usual, where you need to get into a rhythm and deliver things and work through problems and establish policies and so forth.

It’s not a permanent problem, that’s why it makes sense to create a semipermanent structure, and that’s what happened.

So COBR dealt with the initial phase. When it became apparent this was both an extraordinarily complex wide-ranging problem and one that was likely to endure, new structures were required.

Lead Inquiry: The COBR unit, when those extreme pressures were applied, was found not to be sufficient or adequate for coping with those pressures, was it?

Mr Roger Hargreaves: I think my point is that it wasn’t designed for those pressures.

Lead Inquiry: Was it sufficient and adequate whether it was designed or not for those pressures?

Mr Roger Hargreaves: I think I’m – I’m trying to explain, but possibly not successfully, that the Covid crisis went through different phases, and as a consequence COBR had a role in the early phase, it was then superseded by more complex structures with greater capacity, because that’s what the problem became.

Lead Inquiry: All right.

Mr Roger Hargreaves: It’s also the case that whilst the Covid crisis ran on, there was still the prospect of other emergencies, so in government terms it makes sense to be able to stand down the COBR function, so if anything else happens concurrently it’s able to deal with that.

However, I’d also say that it certainly wasn’t a smooth transition, from what I could see from the outside, from the COBR function to the more enduring structures, and what we’ve done since then is create a much clearer operational approach towards that transition.

So I think if we were going through the same experience again, from the off we would understand that we would need immediately to begin to prepare to deliver the Covid taskforce, or, you know, the pandemic taskforce, and COBR would fill the space until it was up and running.

Lead Inquiry: May I now ask you, please, about the Civil Contingencies Act 2004. My Lady’s heard a considerable amount of evidence from Ms Hammond and others about how this is the Act which provides the legal framework to the whole of the United Kingdom’s civil contingencies –

Mr Roger Hargreaves: Yeah.

Lead Inquiry: – arrangements.

I think you were responsible for the team or you were part of the team that drafted the Bill originally between 2002 and 2004; is that right?

Mr Roger Hargreaves: Yes, I led the team.

Lead Inquiry: You led the team. In very general terms, does the Act provide for a series of different legal duties on what are known as Category 1 and Category 2 responders, those responders are a mixture of local responders or, in the case of the DHSC, the Secretary of State and other departments, and those legal duties are designed to ensure that those bodies which labour under those duties are responsible for and are made to plan, to draw up risk assessments, to think about how they might respond in the event of an emergency, how to liaise with other bodies, how to inform the public, all the moving parts of a civil contingencies response –

Mr Roger Hargreaves: Yes.

Lead Inquiry: – both planning and response? Is that a fair summary?

Mr Roger Hargreaves: Well, to be very specific, the duties are largely in relation to planning. The Act does not contain a duty to respond.

Lead Inquiry: Respond.

Mr Roger Hargreaves: The reason for that is actually – I don’t know, it depends on the audience, sometimes people regard this as a complex explanation. It’s a sort of legal explanation, so you might receive a better –

Lead Inquiry: Well, my Lady is a former vice president of the Court of Appeal and a very senior judge, so –

Mr Roger Hargreaves: That’s why I’m hoping for an enthusiastic reception.

There is a broad public sector expectation of reasonableness, so if you have a duty to develop a plan, that broad expectation of reasonableness holds that you will implement that plan if an emergency occurs.

If you have a duty to respond then there is a risk that you create an unfulfillable obligation because of the circumstances at the time.

So the framing of it and the explanation accepted by Parliament was that the combination of the duty to plan and the expectation of public authorities acting reasonably would deliver the effect of response.

So that’s the kind of mechanism behind it, and that is what has happened in practice.

Lead Inquiry: But my question to you was simply designed to elicit that this is a system which imposes legal obligations for both planning and response, because one of the obligations on the variety of local responders, for example, is to plan as to how they may respond in the event of a crisis?

Mr Roger Hargreaves: Yes, absolutely.

Lead Inquiry: Which is why it is a system designed to get ready as well as to plan?

Mr Roger Hargreaves: Yes, and it’s – sometimes people say, “Why is there not an explicit duty to respond?” That’s why.

Lead Inquiry: Okay. After the Act came into force in 2004, how many reviews were carried out by the government as to whether or not that Act was still fit for purpose?

Mr Roger Hargreaves: So there would be various informal and formal reviews on the way. We’re now in a cycle of post-implementation reviews, which happen every five years, we did one relatively recently. That’s part of general best practice in relation to statute, that there is a review. So I suppose we’ve done maybe three of those, perhaps, but there have also been various internal reviews and considerations of the operation of the Act.

Lead Inquiry: You’ve just said that it was envisaged there would be a post-implementation review every five years; how many post-implementation reviews were there within five years of the Act, the 2004 Act?

Mr Roger Hargreaves: So the post-implementation review process, as I said –

Lead Inquiry: How many –

Mr Roger Hargreaves: – applies to all legislation.

Lead Inquiry: I’m so sorry, Mr Hargreaves. How many post-implementation reviews were there within five years of the 2004 Act?

Mr Roger Hargreaves: I don’t think there were any, because it’s a system that postdates the five-year window.

Lead Inquiry: Could you elaborate on that answer?

Mr Roger Hargreaves: The post-implementation review process doesn’t just apply to this legislation, it is general best practice in respect of legislation to do post-implementation reviews, and there’s a process around that. My understanding is that that process, that general expectation of post-implementation reviews, was introduced at some point after the five-year – five years had elapsed from 2004, when the legislation was enacted.

Lady Hallett: So are you saying after 2009, say?

Mr Roger Hargreaves: Yeah, yeah. Yes.

Lady Hallett: So there wasn’t a policy of post-implementation reviews until after 2009?

Mr Roger Hargreaves: Yes, I think so.

Mr Keith: So to say that there was a policy of having a post-implementation every five years after 2004, which is the question I put to you, wasn’t quite right. There was no review within five years of the Act because there was no policy of having a post-implementation review?

Mr Roger Hargreaves: No, there wasn’t at that point. Sorry if I’ve misunderstood your question. But that’s the present system.

Lead Inquiry: So there was a review, was there not, an internal review, called an enhancement programme review in 2012 and then a formal post-implementation review in 2017?

Mr Roger Hargreaves: I thought it was a little before that.

Lead Inquiry: Was there –

Mr Roger Hargreaves: I might – if you’ve got the dates, then you might be correct, I thought it was 2015, but …

Lead Inquiry: In the documents with which you were provided by the Inquiry, Mr Hargreaves, there is a document INQ000056230, we needn’t bring it up, but it is the 2017 Civil Contingencies Act post-implementation review. So would you agree it’s 2017?

Mr Roger Hargreaves: Yeah, that’s –

Lead Inquiry: So it was 13 years after the Act was brought into effect. 2004 to 2017.

Mr Roger Hargreaves: If your question is – I don’t know what your question is, but if it is: is that an unreasonable long –

Lead Inquiry: No, I was just asking you to confirm that, despite the policy of post-implementation reviews, there was no post-implementation review, a formal review, between 2004, when the Act came into effect, as it says on the tin, and 2017; is that correct?

Mr Roger Hargreaves: If that’s the date for the post-implementation review, then yes. There is an awful lot of consideration of whether the Act works properly or not, and how it operates in practice. Post-implementation reviews are, as I understand it, designed to make sure that everyone across government is thinking hard about whether legislation works in practice, but I think it would be wrong to draw the inference from that that no one was thinking about whether the Act was working.

I mean, to give you an example of that very practically, between 2007 and 2008 I ran the team which supported Sir Michael Pitt’s independent review of some catastrophic flooding that had taken place in 2007. As part of that we reviewed – he, as an independent reviewer, looked at the operation of the Act. So it wasn’t the case that everyone just left it idle and it was not being thought about. It was very much a central part of the system and a central feature of debate.

Lead Inquiry: Can you recall, Mr Hargreaves, whether that semiformal, not the formal post-implementation review, but the semiformal enhancement programme review in 2012 recommended significant change to the Civil Contingencies Act 2004, or did it recommend a series of moderate changes, so no departure from the fundamental premise of the Act, which is that there were these legal duties imposed on Category 1 responders and different legal duties on Category 2 responders?

Mr Roger Hargreaves: My understanding is that none of the reviews have recommended a substantial departure from the broad framing of the Act.

Lead Inquiry: Did any review or did the government ever consider bringing together the legal duties on Category 1 and Category 2 responders so that they were similar, or perhaps even the same, or extending the legal duties or a variant thereof that were in the Act to central government?

Mr Roger Hargreaves: Yes.

Lead Inquiry: When was that considered?

Mr Roger Hargreaves: Well, certainly when I was running the Civil Contingencies Bill team in 2004, 2003 –

Lead Inquiry: After the Act came into force. Sorry, Mr Hargreaves, I didn’t make it plain.

Mr Roger Hargreaves: No, but –

Lead Inquiry: After the Act came into force, to what extent did the government or any of these reviews consider significant changes to those duties to bring Category 1 and 2 responders together or to impose a like duty on central government?

Mr Roger Hargreaves: The point I was starting to make is that these things have been features of the debate around the operation of the Act since its original design, and return from time to time as questions, and certainly when independent reviews or post-implementation reviews or anything else is carried out, these points tend to be considered.

There is obviously – you know, there are obviously design principles behind the Act that explain the difference in duties, that I’m happy to talk about more if that’s helpful, and the absence of duties on central government. But these are obvious sort of pressure points in the design of the system, and whether Category 2 responders are doing enough is always a key question, and whether central government needs more obligation around it is obviously a key question too when you’re thinking about how the Act works and how the civil contingencies system operates.

Lead Inquiry: So is the position that whilst there may have been some degree of debate before the Act was passed, following the enactment the government itself, either internally or by way of a formal or semi-formal review, has never suggested that there be wholesale change to those legal duties or the imposition of a duty on central government?

Mr Roger Hargreaves: Well, as recently as the new national Resilience Framework, we talk about doing work to consider the case on whether there should be a duty on central government.

Lead Inquiry: Yes. What year, in that national Resilience Framework, is that work promised by, Mr Hargreaves?

Mr Roger Hargreaves: I don’t think there is a specific date attached to it.

Lead Inquiry: Is it 2025 or 2030?

Mr Roger Hargreaves: I’m not sure.

But there is a – there’s quite a good case for having a duty on central government departments. When the Act was done originally we didn’t do it because it was quite unusual to have duties on central government departments. The broad principle, the broad organising principle was that secretaries of state were able to determine their own priorities and therefore it wasn’t necessary to have a legal duty. I think just in terms of the broad shape in which law applies to government departments, there has been a general move towards having more duties described, particularly around topics which people believe to be particularly important and cross cutting.

So the balance has moved, I think, more, over time, in favour of having a duty of this kind. I mean, certainly in my nice symmetrical bureaucratic mind it would make sense for duties to apply evenly or for there to be a clear line of sight between obligations, but, as I say, it’s a matter that we think does need some proper consideration and should probably be the subject of a consultation, and that’s why there’s a general commitment in the framework.

Lead Inquiry: But despite that change in thinking, Mr Hargreaves, and the point, if I may say so, is well made that there is a case for having a legal duty placed on government, the government’s own 2022 post-implementation review made no such recommendation, did it?

Mr Roger Hargreaves: We said we’d consider it.

Lead Inquiry: Did it call for the legal duty in some form to be placed on central government?

Mr Roger Hargreaves: It said we would look at it. I mean, I … there is … I’ve given you my view, I suppose, on the shifting case, and there’s a commitment to do that. The sort of thing which requires – you know, any legislative change is going to require a consultation. It wasn’t so transparent from the responses to the framework, you know, consultation that there was an absolute expectation that people felt this was necessary, but I think there is a building case, a case that grows over time, to do something specific here.

Lady Hallett: Why do you think that, Mr Hargreaves? Just for those who are watching who aren’t familiar with the system.

Mr Roger Hargreaves: Possibly it is my nice neat bureaucratic mind thinking it, but … I think it is helpful where government cares about something in the round for there to be a consistent set of expectations, and I think one of the broad themes of this Inquiry might well turn out to be whether government takes civil protection seriously enough in the round. In fact not just government, but whether the UK does. On matters like that, sending a signal across government through a statutory obligation can be very powerful and the debate which accompanies it can be very powerful.

It’s also important that, I think, that there is transparency about what government does, so government can be held to account and, again, can foster political debate on the level of ambition. So a statutory obligation is a very effective way to do that. It’s not because I think that government departments don’t take that seriously, I just think there may be room to take it more seriously.

Mr Keith: Could we have, please, INQ000055883, page 1.

This is the post-implementation review of last year published by the Cabinet Office, is it not?

Mr Roger Hargreaves: It is.

Lead Inquiry: If we go forward one page, we can see that it comes from the Cabinet Office:

“Lead department or agency: Cabinet Office.”

It’s dated 29 March last year. It’s a statutory review. The objectives of the measure were, that’s to say the original Act, to: establish a consistent level of civil protection activity; encourage consistency between the responders; define the tasks; ensure local responders retain the ability to make decisions about what planning arrangements are appropriate; and to provide powers for the government to make temporary regulations.

That last paragraph, is that part 2 of the Civil Contingencies Act 2004?

Mr Roger Hargreaves: Yes.

Lead Inquiry: Which provides for emergency regulations applied by a system of regional directors or perhaps governors, if the emergency arrangements are triggered. Has that part 2 of the Act ever been used in the United Kingdom?

Mr Roger Hargreaves: It’s not.

Lead Inquiry: No. Was it used at the time of Covid, Mr Hargreaves?

Mr Roger Hargreaves: No. When the Bill went through Parliament, this point was discussed – you know, when we would use it was discussed at some considerable length, and there was concern that government would use it too freely. There’s obviously a fair sort of back story on the use of emergency powers by government and so forth.

What government committed to Parliament at the time is that it would only use emergency powers where it was not possible to use normal constitutional routes. I think, in a sense, emergency powers are a bit of a – they’re a kind of constitutional aberration which has been co-opted into the constitution, it’s a device for making legislation when it’s not possible to do it through normal routes.

Lead Inquiry: Do you mean when it’s not possible to bring a Bill or statutory –

Mr Roger Hargreaves: Yes.

Lead Inquiry: – legislation before Parliament?

Mr Roger Hargreaves: Yes.

Lead Inquiry: Right.

Mr Roger Hargreaves: So I think there is a misconception sometimes, people think it’s a list of things government can do and it just picks and chooses. Actually, it’s a mechanism for making emergency legislation at high speed through secondary legislation, but often with the kind of reach of primary legislation, and it’s designed to be temporary, and designed to have just a much more – a much faster mechanism for delivery.

Lead Inquiry: All right.

Could we go over the page, then, please.

“What evidence has informed the [post-implementation review]?

“The National Resilience Strategy Call for Evidence public consultation … Workshops and engagement events …”

There were, were there not, as it says, there was a call for evidence and I think there were some surveys done, and individual workshops and engagement events carried out?

Then this at 3:

“The Act continues to achieve its stated objectives. Duties are placed upon local responders, with the principle of subsidiarity ensuring they retain the flexibility to collaborate in a way that is suitable to their specific needs. The recommendations made (including changes to the guidance) aim to strengthen the fulfilment of the Act’s objectives, but there is no case at this stage for a fundamental overhaul of the legislation. Whilst the objectives and the Act’s fulfilment of them are broadly fit for purpose at present, the evolving risk landscape, as well as work on the Integrated Review commitments to consider strengthening LRFs and develop a National Resilience Strategy, may create a need for further changes to the Act in future.”

Mr Hargreaves, in relation to your earlier answer that this post-implementation review stated that there would be and there was a debate to be had about the imposition of legal duties on central government, where is that reference? Where do we find the reference in the review to that debate to which you said it made plain reference?

Mr Roger Hargreaves: It’s the reference to the national resilience strategy, which emerged as the UK Resilience Framework, which includes the commitment to look at that.

Lead Inquiry: This review, if we go back to the first page, was in March of last year. The framework, the national Resilience Framework, was published in December.

Where is the reference in this review, the reference which you said was in it, to debate being given, consideration being given and a debate revolving around the imposition of a legal duty on central government?

Mr Roger Hargreaves: It would be a point raised in consultation responses from local resilience forums.

Lead Inquiry: Where is it in the review, Mr Hargreaves?

Mr Roger Hargreaves: I’d have to look through the review and find it.

Lead Inquiry: So the position of the review was that no fundamental change was recommended, there should be no significant overhaul, there should be no imposition of legal duties on central government, and no real change to the relative legal duties imposed on Category 1 and Category 2 responders; is that correct?

Mr Roger Hargreaves: Yeah. I mean, the Act provides for local response organisations to carry out civil protection in a systematic way, assess risks, develop plans, and so forth, and that holds good. It provides for an emergency legislation-making mechanism, and that holds good. Over time, and, you know, partly from the responses to the consultation around the review, partly from policy debates inside government, partly in response to events, we will contemplate extending elements of the Act, or other bits of legislation that apply to emergencies.

So … so this does hold good as a piece of legislation, but that doesn’t mean that there isn’t necessarily room for change.

Lead Inquiry: Coincidentally last year in March your predecessor, Mr Mann, from whom the Inquiry heard, co-chaired a National Preparedness Commission review of the CCA 2004, did he not?

Mr Roger Hargreaves: So I understand, yes.

Lead Inquiry: Have you read that review?

Mr Roger Hargreaves: His review?

Lead Inquiry: Yes.

Mr Roger Hargreaves: I have looked through it, yes.

Lead Inquiry: Yes, because, of course, it’s fundamental, is it not, to any proper consideration of the CCA 2004; would you agree?

Mr Roger Hargreaves: Well, not quite.

So we get very many think pieces from consultants, academics and so forth, on how the system of civil protection should be organised, which reflects their views. The National Preparedness Commission, the lay observer might conclude from the name that it has some government status or official role. It doesn’t, it’s a sort of think tank. And the independent review is independent in the sense that it has nothing to do with government, not in the sense that this Inquiry is independent, for example.

Lead Inquiry: That’s good to hear, Mr Hargreaves.

The document that you describe as a think piece was a document prepared by the National Preparedness Commission, a relatively august and independent body, and the report which I’m holding up in my hand by Bruce Mann, Kathy Settle and Andy Towler, ran, perhaps in a way analogous to Mr Mann’s expert report for this Inquiry, to some 351 pages.

It was an extremely complex, detailed, thorough investigation of the workings of the CCA 2004 prepared by an independent body which is solely concerned with national preparedness.

Is it just a think piece?

Mr Roger Hargreaves: Yes. Yes, it is. And if – look, there are many organisations that operate in the field of civil protection, many of them are able to draw on people with a great deal of expertise, and in government you get many – many of these sent to you, and you need to have a look at them. In the context of an ongoing statutory consultation, you have to take some care around what you get, and you have to give fair balance to everyone who might wish to contribute.

The National Preparedness Commission is a relatively new organisation. It has some august people on it, but there are other – other similar bodies available, and it is a very long report, which I looked through with interest because I have a great deal of respect for Mr Mann, but I did not prioritise its comments over anyone else’s, because that would not be proper.

Lead Inquiry: What was the core finding of your predecessor’s National Preparedness Commission report, the primary finding in relation to UK resilience and the legal framework, the structure, the CCA, that underpins it?

Mr Roger Hargreaves: I don’t know.

Lead Inquiry: You don’t know the main conclusion or finding of this piece of work done by your predecessor and the Preparedness Commission into resilience and the Civil Contingencies Act 2004?

Mr Roger Hargreaves: I could give you a broad description of the findings, but I couldn’t tell –

Lead Inquiry: Please. Could you tell us, please, a general description of the findings?

Mr Roger Hargreaves: Well, they’re in the similar vein to the expert report produced by Mr Mann and Professor Alexander, that they seek a reform of aspects of the system. Some of it relates to the fine detail of how civil protection work is done. There are some broader proposals. It’s slightly different in focus to what we think the focus should be inside government, and what we concluded through our public consultations and statutory reviews and so forth. There is a slight – you know, there is a slight difference of opinion between us and the team that did that about where the focus should lie.

Lady Hallett: Can you analyse or summarise the focus, difference in focus?

Mr Roger Hargreaves: In very simple terms, the people who wrote that report are people who specialise in providing quite detailed advice to people around quite detailed tasks. The main thrust of work in government is focused on getting more upstream of emergencies, doing more preventative work, trying to ensure that there is a very, very broad public understanding and greater public and political engagement in risk, because that’s what shapes outcomes.

I think we are interested in moving the whole system to a better place, and their report is focused on moving the operation of those bits of the system that do specific civil protection work to a better place.

Mr Keith: Mr Hargreaves, you’ve just stated that there was a – I didn’t quite catch the word, but there was a difference of view:

“… there is a slight difference of opinion between us and the team that did that report about where the focus should lie.”

The post-implementation review carried out by the government last year, as we’ve seen, said there is no case for a general overhaul.

The primary finding – and we’ll have, please, page 10 of INQ000187729 – is that whilst the Act and the resilience arrangements it introduced were a “vital step down the road to building a Resilient Nation”, and whilst they’ve “served the [United Kingdom] well over the past 18 years” and provided a “sound basic framework”, the:

“… pace of development has not been sustained over the past decade. In some important areas, quality has degraded. As a result, UK resilience today has some serious weaknesses. It is not fit for future purpose in the world the [United Kingdom] is moving into.”

Is that a slight difference of opinion?

Mr Roger Hargreaves: I think there’s a lot of that which I would agree with.

Lead Inquiry: And the recommendations, could we have, please, 272. Summary of recommendations, the authors of the report make 117 recommendations, but two are of particular importance. 275, please. Recommendations 29 and 30. Who should have legal duties? 29:

“The full suite of Category 1 responder duties should be placed on the organisations currently designated under the Act as Co-operating Bodies … The [United Kingdom] Government should pursue and capture in statutory guidance ways in which the additional burdens of fulfilling the new duties might be reduced for example by activity undertaken at multi-[local resilience forum]/regional level.”

Then this:

“The full suite of Category 1 responder duties should be placed on the [United Kingdom] Government.”

So to the extent that the 2022 post-implementation review by the government said there was no case for overhaul, is it your position now that you don’t agree with that conclusion and you do agree with the National Preparedness Commission view?

Mr Roger Hargreaves: No, my position is consistent. What – some of this is about how to achieve the ends. Right? The Act is the Act and describes the obligations that fall on people at the local level. When it comes to the post-implementation review and testing the fitness for purpose of those obligation, the conclusion of our post-implementation review reflected – which reflects the consultative process that we ran, to which Mr Mann contributed through this report, concluded that what we had was broadly fit for purpose but suggested some small changes.

I don’t disagree at all that Category 2 responders should absolutely take civil protection seriously. The problem with the analysis is that that doesn’t necessarily mean you do that through the Civil Contingencies Act.

Category 2 responders are generally regulated utilities or other service providers of critical infrastructure. They are subject to incredibly detailed regulatory regimes which impose a wide variety of different burdens and expectations on them, through very carefully calibrated regulatory frameworks that balance the cost to the customer with service delivery, with how they perform in emergencies, for example.

Therefore I think we remain of the view that the obligations on Category 2 responders are, on balance, best delivered through those regulatory frameworks.

I do, however, think there is a case for contemplating whether those regulatory frameworks, in light of the Covid experience and other recent emergencies, are clear enough and enforced with sufficient vigour.

But if you place Category 2 responders in Category 1, you place quite a substantial burden on them to get involved in emergencies which have little to do with them.

So, there are different ways to cut the cake, and there’s where I think we disagree, but I don’t think we disagree on whether Category 2 responders who provide essential services should have clear civil protection obligations, it’s just that we disagree about whether they should be in the Act, the Civil Contingencies Act, or not.

Lead Inquiry: What about the imposition of legal duties on the United Kingdom’s central government? You are now recorded as saying that, although it finds no reflection on the face of the 2022 review, the governmental review, that it was apparently raising that as an issue for debate?

Mr Roger Hargreaves: Yes.

Lead Inquiry: Although, as I say, we can see no reference to that being the position of the government in the review. And you say that that is something which the December 2022 Resilience Framework has in mind. Is that right?

Mr Roger Hargreaves: So, again, the post-implementation review is about how the Act operates. As it says in the passage that you put up, highlighted, potential extensions to the Act would be a matter for the national resilience strategy, as we were saying, called, now, UK Resilience Framework. As I also said earlier, I myself am pretty sympathetic to that recommendation, and think it has merit and probably more merit than it has when we did the original Act.

So I think there I’d be in agreement. I mean, you know, just to say in the round, it might be helpful to say, Mr Mann and Professor Alexander and I agree on almost everything. We are after the same thing. There are some constraining factors that fall on you when you are an official in government, as distinct from when you are a consultant in the field of civil contingencies, whatever your background. Like, for example, resource.

Lead Inquiry: So if you agree on almost everything, do you agree there is an unanswerable case for the imposition of legal duties on central government?

Lady Hallett: I think you’ve got your answer to that, Mr Keith, to be fair.

Mr Keith: All right.

Shall we have a look, then, at the document itself.

INQ000097685, the Resilience Framework of December 2022, page 1, please.

So this was a document produced by the Cabinet Office. We heard evidence from the Deputy Prime Minister yesterday that he wrote – I think he said he wrote the foreword or he certainly appeared in the foreword, along with his photograph.

This is a document which plainly has the involvement of the Civil Contingencies Secretariat in it before the split occurred between the COBR unit and the resilience function, now in the Resilience Directorate, the national security directorate. Presumably you had a great deal of involvement in the production of this framework?

Mr Roger Hargreaves: A very great deal. So I was involved very heavily – you know, I oversaw the work on this through till the summer of 2022 and after the split, obviously I retained an interest but I didn’t produce the very final, final draft.

Lead Inquiry: No, you left in July 2022. But it must stand to reason that this document which is – well, in terms of pounds and kilograms, it’s a less weighty document than the National Preparedness Commission report, but it’s a sizeable beast. Presumably the first draft was drawn up before July 2022 whilst you were still the director of the Civil Contingencies Secretariat?

Mr Roger Hargreaves: Absolutely. I think that if – the government experienced a bit of turbulence in that period. I think if it hadn’t, we might well have published it within my tenure.

Lead Inquiry: All right.

Could we look, please, at page 5. We can see in the contents page the way in which the report is divided: there is an executive summary, and then the action plan from the government for risk, responsibilities and accountability, partnerships, communities, investment and skills, and there is a summary of the framework actions, as they’re known, on page 72.

Did your then department’s framework document divide up the actions by timescale? So it identified a number of things that the government was already doing, and a number of things that would be done by 2025 and a number of things that would be done by 2030?

Mr Roger Hargreaves: Yes.

Lead Inquiry: Perhaps we could just look at some of the things in relation to which the United Kingdom government is – that it is already taking action.

So in fact Mr Dowden was asked about this yesterday. Under the broad heading of “Risk”, there’s a reference to:

“Refreshing the … (NSRA) process, so it will look [at] a longer timescale … multiple scenarios …”

Indeed, the 2022 risk assessment process last year was significantly different from the 2019 version because of the reference to multiple scenarios?

Mr Roger Hargreaves: Yes.

Lead Inquiry: Then this:

“Creating a new Head of Resilience to guide best practice, encourage adherence to standards, and set guidance.”

In which part of the government has a new head of resilience been created? And the emphasis is “created”. In which part of the government has a new head of resilience been created?

Mr Roger Hargreaves: The head of resilience is – leads the Resilience Directorate inside the Cabinet Office.

Lead Inquiry: There was already a director of national resilience in the Cabinet Office, a full-time post, from March 2020 to May 2022. So to what extent was a new head of resilience created, Mr Hargreaves?

Mr Roger Hargreaves: It is an entirely new role.

Lead Inquiry: In what regard is it an entirely new role?

Mr Roger Hargreaves: In the sense that it didn’t exist before and now exists.

Lead Inquiry: So –

Mr Roger Hargreaves: It is the part of the job that I did as CCS director separated out, in the fashion that we talked about earlier –

Lead Inquiry: So it’s a job that was already a job being done by you when you were director, it has simply been hived out from your old job, but it is a head of resilience.

To what extent is a head of resilience different from a director of national resilience, which was a pre-existing full-time post?

Mr Roger Hargreaves: I think that was a role in the national security field less related to this kind of resilience. This is about a head of resilience that superintends our national civil protection system, particularly in relation to civil emergencies.

Lead Inquiry: No new post was created, was it, Mr Hargreaves, other than insofar as an existing post was given a different name?

Mr Roger Hargreaves: I don’t know how more plainly I can say this, it’s literally a new post. It’s a new post on headcount, it’s a new person, it’s a new title. It carries out some of the functions that were done previously, but because it is a separately identified post, the person is able to do that with more focus and weight that I was able to do, or Katharine was able to do, or even Mr Mann was able to do, when they were together.

Lead Inquiry: The reason it’s a new person, Mr Hargreaves, is that the previous incumbent of the post of director of national resilience happened, coincidentally, to leave that post in May 2022, before this report was even published, to go to join a job in the Ministry of Defence. So it’s not that there is a change of person because a new post was created, it’s just that the previous incumbent happened already to have left the post. Isn’t that correct?

Mr Roger Hargreaves: It’s just not correct.

Lead Inquiry: All right.

Mr Roger Hargreaves: This is in a different bit of the forest. The fact that the two titles include the word “resilience” does not mean they are the same thing.

Lead Inquiry: All right.

The government is:

“… already taking action by:

“Strengthening [United Kingdom] … resilience structures by creating a new resilience function …”

You have given evidence how the existing Civil Contingencies Secretariat was split into the more practical side, the crisis management side, the COBR unit, and the Resilience Directorate within the Cabinet Office. Both parts, the COBR unit and the Resilience Directorate, are both formed from the pre-existing Civil Contingencies Secretariat, are they not? There is nothing new in either part that wasn’t already in the Civil Contingencies Secretariat, is there?

Mr Roger Hargreaves: Not quite – that’s not quite right. So some of this is about the purpose and the focus of the Resilience Directorate, and that in turn is shaped by the Resilience Framework. Our ambition is to be more expansive and more – I suppose the term we would use is “upstream”, but preventative in our approach to civil protection. So that directorate spends less time looking at the detail of policy and procedures, and – on balance, and more time trying to think about the broad operating context of the UK and whether you can solve problems.

So do you want to put your effort into, for example, having very detailed plans to deal with an energy security problem, or do you want the UK to have better energy security in the first place?

Lead Inquiry: Is that reference to a new resilience function simply a reference to part of the old civil contingencies directorate which has been renamed as the Resilience Directorate?

Mr Roger Hargreaves: That’s where it starts from, but in terms of its purpose and its focus, it is evolving to a different place.

Lead Inquiry: In terms of headcount or objectives or legal scope, in what way has it changed?

Mr Roger Hargreaves: It would have a different – slightly different framing in terms of its objectives, to be more clearly focused on system-wide reform and prevention. But in terms of headcount, it is very similar to what was there before.

Lead Inquiry: Page 73, please.


“By 2025, the [United Kingdom] Government is committing to take the following actions:

“Clarify roles and responsibilities in the UK Government for each NSRA risk …

“Conduct an annual survey …

“Introduce an Annual Statement to Parliament …

“Develop a measurement of socio-economic resilience …”

What is that a reference to? What is a measurement of socio-economic resilience?

Mr Roger Hargreaves: When you have an emergency there are – vulnerabilities manifest in different forms, and obviously you’ve heard from expert witnesses who have talked about this.

In very sort of brief terms, there are three kinds of vulnerabilities we observe in emergencies. The first is sometimes an emergency just affects a particular category of people. Covid is a very good example of that, because there’s one particular group profoundly affected and that was the elderly, and they were affected disproportionately.

Sometimes you have vulnerabilities that arise because they pre-existed and were carried into the emergency. That’s a lot of what Professors Marmot and Bambra talked about. If someone struggles to access public services because English is not their first language before an emergency, they will continue to struggle and may even struggle more profoundly during the emergency itself.

The third kind of vulnerability relates largely to people’s ability to shape their own destiny, which largely comes down to how wealthy people are and how healthy people are.

So, understanding the landscape of areas that are impacted by emergencies and knowing that if we are – you know, if we face a particular problem in a particular area, it will be hit more badly than if that same problem was to arise in a different place. It’s a very helpful way to make sure we’re managing the emergency very effectively and we get further ahead faster on the protection of people with vulnerabilities during a moment of crisis. So that’s the kind of work that we are now advancing.

Lead Inquiry: “Partnerships”, further down the page, the government is committed to providing by 2025 a:

“[Growing in] the [United Kingdom] Government’s advisory groups made up of experts, academics and industry experts in order to inform the NSRA. This may include establishing a risk-focused sub-group of the UK Resilience Forum.”

Now, in the body of the report, I won’t take you to it, Mr Hargreaves, paragraphs 130 – and these are the paragraphs in which this conclusion is drawn – 131, 132, 133, 134, 135 and 136, there are references to how the government will do this, what ways in which the advisory groups will grow. But all those paragraphs do is make reference to the existing structures, to SAGE, to STACs, to the United Kingdom resilience function, the UK Resilience Forum, and they say:

“… the Government is committed to inviting expert challenge and input …”

It will “actively and regularly draw on … expertise”.

So the question for you is this: in what way over the next three years, two years, does the government envisage that the advisory groups will be grown? Do you have it in mind to start, to put into place from scratch a new expert body, a new forum for expert advice? What did you have in mind when you wrote this report?

Mr Roger Hargreaves: It was my view when I arrived in post at the end of 2020 that one aspect of our work that was not fully developed was how we made best use of experts. There were some places where we did it really well and had very well developed structures, SAGE is quite an interesting example of that, but more generally there was a question of whether we were tapping enough into that expertise. So I was quite keen to pursue relatively ambitious change on this. A lot of it had already been done.

We shifted, with helpful guidance from the Royal Academy of Engineering, how we were using experts in the risk assessment process, to really sort of aggressively broaden it out and to try to maximise the number of external experts who could challenge what we were thinking within that process.

We established the UK Resilience Forum, which is designed to allow representatives of all parts of society to come and sit with government and talk about resilience challenges.

So I was quite keen to embrace quite quickly some quite big shifts in how we used experts.

I think my expectation would be that that establishes a trend and we find more and more ways to involve them over the coming period.

So, to the extent that this recommendation represents radical change, we’ve already done that. It’s now a case of evolving that further in the same direction, I’d hope.

Lead Inquiry: Three final areas, please, Mr Hargreaves. On page 74 we have the list of actions that will be done by 2030, eight years hence from the date of the report, to nine years hence from now.

The communication on risks, proposals to make communications on risks more relevant and easily accessible will be drawn up. Work will be done across the three pillars of reform to strengthen LRFs. Standards on resilience will be introduced across the private sector. Better guidance will be provided to the wider private sector. Resilience standards for the CNI and a review of existing regulatory regimes on resilience, to ensure that they’re fit for purpose.

To what extent has the government agreed by 2030 to impose any sort of significant change on the government itself, either in terms of its legal duties or core discharge of its primary functions?

Mr Roger Hargreaves: There isn’t a firm commitment in the way that we might have in some areas, but, as I’ve explained in previous answers, it is something which I expect us to pursue in a – through discussion with those people who are – who have an interest in it. And as I’ve explained, my personal view is that there is a strong case for moving in that direction.

Lead Inquiry: The bottom bullet point under “Partnerships” says the government by 2030, so in seven years’ time, will “review existing regulatory regimes on resilience”.

Does that simply mean it will again review the Civil Contingencies Act 2004?

Mr Roger Hargreaves: Well, it will again have to do a post-implementation review, but this is about the regulatory regimes which fall on those outside government, who are adjacent to government. That’s the kind of point about the partnerships bit of the report.

The idea that the framework introduces is essentially you’ve got government, which has sort of formal responsibilities, and then you have the sort of public at large, which includes communities, smaller businesses and so forth. But you’ve got this category which we talk about as – in the “Partnerships” section, which is essentially things which are adjacent to government and deliver services that the public, I suppose, regard as public services but are not of the public sector. So a lot of these recommendations are about the regulatory and other statutory regimes that exist and the strengthening of those.

This is the point that the Civil Contingencies Act doesn’t need to cover everyone everywhere on everything, because there are lots of other statutory and regulatory regimes that sit alongside it. And our organising principle around the supply of public utilities, say, is that we regulate a sector and its delivery. So we regulate the water sector, and that includes how much people pay and supplies of water and maintenance and all kinds of things. And part of that overall framework is obligations in relation to risk and emergencies. And it’s that bit which can be tested.

Lead Inquiry: At paragraph 60, on page 29 of the Resilience Framework, it is said – this is said:

“The [United Kingdom] Government will consider a range of options for improving this and develop an action plan to deliver these, including by developing proposals for formalising duties on the United Kingdom Government departments, particularly in respect of working with Local Resilience Forums and wider local responders … on resilience across the whole resilience cycle. Any new duty would be subject to an impact assessment.”

So is the government’s position that it will either consider a range of options for developing proposals for formalising duties, which may consider – may recommend a new duty, or is the government committed (b) to the imposition of a new legal duty on central government?

Mr Roger Hargreaves: I think the position is as described there, which is there will be a process to weigh up the case for imposing those obligations. The detail here specifically is reference to, if you impose those obligations, doing it in the right way.

So, for example, you would not make every government department a member of every local resilience forum, because they would collapse under their own weight. There is a means for co-operating with the local level through the Department for Levelling Up, Housing and Communities, so it’s not about replacing that, say.

Lead Inquiry: All right.

Resourcing. One of the points made to my Lady in the expert report from Mr Mann and Professor Alexander was that this Resilience Framework is silent on resourcing.

Now, a little research demonstrates that the word “resource” or “resourcing” appears 19 times in the report. Page 58, I won’t bring them all up, it says it is “important that investment in resilience is considered and co-ordinated”. “Implementation will be iterative and will take time”. There must be a “co-ordinated approach to our investment in resilience”. Resilience investment within the United Kingdom government must be mapped. The government will “consider options for funding models for any future expanded responsibilities and expectations”.

Is the position of the Resilience Framework that there is no commitment yet to increased resourcing, there is instead a commitment to consider options for future resourcing?

Mr Roger Hargreaves: Yeah, I think that would be fairly summarised as: there’s no new money, there might be less money, but if there are good proposals, who knows, there could be more money. That is the kind of honest answer on that point. Government is very good if it is spending more money in telling you it is spending more money. It is not spending more money here and might spend less.

Lead Inquiry: That, if I may say so, Mr Hargreaves, is an excellent summary.

The last question concerns inequalities and vulnerabilities. Is this the general position, that none of the planning or the guidance or very little of the planning or the guidance pre-Covid pandemic, in relation to civil contingencies and preparedness across the nation, paid any regard to the individual circumstances of the vulnerable or marginalised sectors in our community? There were references to the important legal obligation under the Equalities Act of the public sector equality duty, but that in no part of this complicated factual and legal policy-driven process for contingencies was any duty imposed on anybody to consider the specific needs of particular parts of the community?

Mr Roger Hargreaves: The way in which all of our civil protection is organised is to run with the flow of existing functions. So we think that the people who are best placed to plan for the delivery of local public services in an emergency are those people who have those functions day to day. It kind of runs through everything that we do. When it comes to vulnerable groups – it’s like a central organising principle.

When it comes to vulnerable groups, there is a great deal of expectation on those organisations already, and if you talk to any local authority or public health organisation, the needs of vulnerable people is very, very central to their kind of existence and their focus.

The expert report on this talks a lot about the very wide range of guidance that is available. It is all framed by that idea, though, that we are asking, reminding, telling people that they need to, as they would do ordinarily, factor the needs of the vulnerable into their emergency planning, and then, by extension, their response.

The pandemic is quite interesting in these terms, because of its duration. It’s very difficult to engage in social engineering, improve social outcomes during a two-week emergency. But where you’ve got an emergency that runs over a year or two, you’re making a different kind of decision. You’re not just pulling operational levers to restore control. You’re actually shaping a response over time. And in terms of the mechanics of how government works, it’s less simply an operational task and has more of a policy element.

So what was described by your expert witnesses is really very interesting and thought provoking about how government introduces the best practice it would apply to policy during the policymaking in normal day-to-day business into emergencies of long duration where vulnerabilities may emerge and there is enough time for a kind of feedback loop: we did this, it didn’t work properly, let’s redo it again. Which you wouldn’t get in a tighter crisis.

Mr Keith: My Lady, there are no questions posed by the core participants which I have not already addressed in my own examination, or in relation to which you have declined permission. That being so, there are no further questions.

Lady Hallett: Thank you very much, in which case we shall break now, I will return at 11.35.

Thank you very much indeed for your help, Mr Hargreaves.

The Witness: Thank you.

(The witness withdrew)

(11.18 am)

(A short break)

(11.35 am)

Lady Hallett: Mr Keith.

Mr Keith: My Lady, the next witness is Professor Sir Chris Whitty.

Sir Chris, if you could be sworn, please.

Professor Sir Whitty


Questions From Lead Counsel to the Inquiry

Lady Hallett: Please sit down.

Mr Keith: Sir Chris, thank you for your assistance. My Lady is aware that you have provided a number of witness statements, both to this module and in fact to Module 2. Whilst I ask questions, could you please remember to keep your voice up so that we may hear you properly, and also so that your evidence may be recorded by the stenographer. If I ask you a question which is not clear, please don’t refrain from asking me to repeat it.

Sir Chris, you are, as is very well known, an infectious disease epidemiology and acute medicine clinician. You are and you have been now for some time the Chief Medical Officer for England.

You were appointed on 2 October 2019 as Chief Medical Officer for England and, in essence, that is the Chief Medical Adviser to His Majesty’s Government. Is that correct?

Professor Sir Whitty: (Witness nods)

Lead Inquiry: Was your predecessor Professor Dame Sally Davies and have your deputies been, at one time, Professor Sir Jonathan Van-Tam, until 2022, and Professor Dame Jenny Harries, until 2021, when she became chief executive of the United Kingdom Health Security Agency?

Professor Sir Whitty: Those are all correct. The one thing just to – a minor amendment, is that I stopped doing acute medicine when I took up the role of Chief Medical Officer in 2019, but I still do infectious diseases and, indeed, over the Covid period did 12 weeks’ rota on the words for Covid over that period. So I saw it firsthand and I can say to the families who are here I saw the extraordinary impact and devastation that had for individuals and the families.

Lead Inquiry: Thank you. Before that, before you were appointed Chief Medical Officer, were you the Chief Scientific Adviser for the Department of Health and Social Care between 2016 and 2021, so there was an overlap in fact?

Professor Sir Whitty: Yes.

Lead Inquiry: Were you also formerly head of the National Institute for Health Research, NIHR?

Professor Sir Whitty: Yes.

Lead Inquiry: I believe that you were interim Government Chief Scientific Adviser between 2017 and 2018?

Professor Sir Whitty: Correct.

Lead Inquiry: You were the Chief Scientific Adviser at DfID. You were until very recently a member of the executive board of the World Health Organisation, and you remain, I believe, a member of the Department of Health and Social Care’s Executive Committee, ExCo.

There are, if I may say, too many honorifics, qualifications and fellowships with a huge range of august bodies for me to list them, but you are, by training, a professor of public and international health and you were a professor of public and international health at the London School of Hygiene and Tropical Medicine, and, perhaps primarily, a fellow of the Royal Society, the Academy of Medical Sciences, the Royal College of Physicians and an honorary fellow at a number of other organisations?

Professor Sir Whitty: Yes.

Lead Inquiry: For the particular purposes of addressing the issue of preparedness, were you involved in the response to many United Kingdom and global medical and wider emergencies?

Professor Sir Whitty: I was, over quite a period of time.

Lead Inquiry: Were you concerned, therefore, with the response to the HIV emergency, health emergency, to the Ebola emergency, and the emergencies connected to the Zika outbreak abroad and the Novichok poisonings in Salisbury and Amesbury?

Professor Sir Whitty: Yes to all of those, and the HIV was as a clinician rather than as a member of government.

Lead Inquiry: Thank you.

Have you also been at various times a chair or a member of a number of the important advisory disease committees which exist within the United Kingdom?

Professor Sir Whitty: Yes.

Lead Inquiry: All right. Well, we’ll come back to the detail of those in due course.

Also, and it’s relevant again to this module, together with the Chief Medical Officers for Scotland, Wales and Northern Ireland and the Government Chief Scientific Adviser and the NHS National Medical Director and a number of other people including relevant Deputy Chief Medical Officers in the United Kingdom, did you write what is known as the Technical report on the Covid-19 pandemic in the [United Kingdom]?

Professor Sir Whitty: I did. This was aimed specifically at our successors, so it’s in places quite technical, as the title implies, but it is, I hope, helpful to this Inquiry and indeed more generally to lay out some of the scientific and medical issues.

Lead Inquiry: So that we may get our bearings, is it a report, a very considerable report, addressing the questions of disparities, research, situational awareness, modelling, testing, contact tracing, NPIs, care homes, pharmaceutical interventions, improvements in the care of Covid and communications. So traversing, in fact, the whole scope of the response to Covid and the preparedness for Covid with which you were directly personally and professionally concerned?

Professor Sir Whitty: Yes.

Lead Inquiry: All right.

I don’t propose, Sir Chris, to ask you about matters which more properly fall within the scope of Module 2, so let me make it absolutely plain, there will be no questions today about the government’s response to the pandemic. Those are matters for the future.

I’d like you instead to focus, please, firstly on some of the structures which play a very important role in the emergency preparedness resilience and response system in the United Kingdom.

As the Chief Medical Officer, are you assisted by a body known as the Office of the Chief Medical Officer? If so, what is that?

Professor Sir Whitty: So I am and am very fortunate to have a very able but small group, as Dame Sally said in her evidence. Normally this runs as it does at the moment at around 12 people, which includes myself and the Deputy Chief Medical Officers, and then some private secretaries and medical – public health registrars.

Lead Inquiry: With the benefit of the hindsight that comes with responding to the Covid pandemic, is there anything that you would wish to say about the size of that office or the degree of assistance or the resources associated with it? Did it stand the test of time in light of the terrible demands of the pandemic?

Professor Sir Whitty: My view is that the size, which expanded up to about 19 people at peak during the pandemic, was the right one for the job we were asked to do, which was advisory. There were others who helped me with some of my more executive functions because I was still, in the early stages, running the National Institute for Health Research. That was a significant, slightly different body of work. But my general view is a small, very, very good group is easier to provide clear advice to people than a much larger and often more unwieldy group.

Lead Inquiry: Turning then to some of the other bodies concerned in the EPRR system, is it important to distinguish between those bodies which provide on a permanent basis scientific advice and those bodies which are, to use a terrible modern colloquialism, stood up to deal with the response to civil emergencies? Does that divide exist, and why does it matter?

Professor Sir Whitty: So that divide does exist. There are a number of bodies which give advice irrespective of whether there’s an emergency or not. Some of those are relevant in emergencies, if they happen in their area of work. So, for example, the group NERVTAG, which we may come back to either now or in later modules, I know you’ve had previous evidence on it, was very important in this emergency and it also runs between emergencies. But there’s an apparatus that stands up particularly around SAGE for major emergencies which acts both as a way of funneling information to central government in a coherent way, but also, and I think this is important in the way we think about it, as a co-ordination mechanism for how to prioritise the advice that’s given.

So I actually think during emergencies there is better co-ordination of scientific advice than there is outwith emergencies, and I think that actually may be a weakness between emergencies.

Lead Inquiry: In your witness statement, you state that the United Kingdom science advisory system, and we are concerned only now with the particular committees and the particular groups that give specific advice, is a complex one and not perfect but is considered to be one of the stronger ones internationally.

Is it your view that whilst changes could be debated and recommended perhaps to some of the individual committees and their remit, their diversity and their constitution, in a general sense there is no systemic weakness in the system by which scientific advice is provided pre-emergency?

Professor Sir Whitty: I think that there is – there are no structural problems that I think need to be changed. There can be issues as you say of detail. I’m always quite cautious of changing structures as a way of trying to fix problems. However, I think what this did demonstrate was that whilst the system can be extremely fast-moving during an emergency, I think it is sometimes less well co-ordinated between emergencies, and I think from that some problems actually arose.

Lead Inquiry: Is that a problem which emanates from the way in which committees may be brought up to speed at great speed in the face of an emergency, and therefore placed under very considerable pressure by contrast to their normal operating procedures?

Professor Sir Whitty: I think it’s more that it is very clear they’re operating around a single aim and all feed into that single aim, whereas the danger in between issues – and 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.

Lead Inquiry: But SAGE is of course a response body?

Professor Sir Whitty: Exactly.

Lead Inquiry: We will come back to the issue of groupthink, as it’s been described, a little later. But in terms, again, of the structures, that is to say the existence of the various committees, putting aside the detail perhaps of their composition and scope, would, in your view, any significant change in the structures lead to an appreciable improvement?

Professor Sir Whitty: Not in my view. You need to have people who are similar enough that they can have a serious conversation and difficult enough that they can challenge one another and bring different perspectives, and I think the structure is probably a reasonable point between the two extremes.

Lead Inquiry: Is there any better international system used by other countries which is worth emulating or not?

Professor Sir Whitty: We’ve looked around the world. I mean, there are bits of other systems, certainly in the global west and north, which we’ve learnt from. But I think generally the UK is seen to be a very strong system.

I think what we don’t probably have as much sight of is, for example, systems in China or some of the other countries in Asia, and I think it is an opportunity to rethink: are there things we could learn from those parts of the world? But certainly in Europe, in North America and other countries we normally deal with, I think most people would see the UK as having a strong system.

Lead Inquiry: May I ask you about two generic risks that you identify in your second witness statement concerning the personal composition of these advisory groups, that is to say the members of the groups.

Firstly, do you identify that going forward there is a growing risk in relation to the availability of the requisitely qualified and expert members to take part in this committee work? Is there a problem developing in relation to the ability of such experts to make themselves available for potentially quite lengthy periods of time?

Professor Sir Whitty: I mean, I think we have been extraordinarily lucky in the UK of having a tradition of the best people doing this, and this has happened over very many years. I think there are two potential threats that we need to be very alive to, the first of which is the university system has got more hawkish, if I can put it that way, about recovery of time and what are the people that they’re paying spending their time doing. I see this as a very major part of the contribution of science to society, but obviously for individual institutions that’s an issue. So that’s a kind of mechanistic one.

Then I do think that what occurred during Covid, where the level of abuse and, in some cases, threat to people who volunteered their time is an extremely concerning one, and one we should be very firm in saying that the society very much appreciates the work of these people, who put in enormous amounts of time, usually at no recompense.

Lead Inquiry: You would no doubt have given some considerable thought to that issue, because of course you were, I’m very sorry to say, a recipient of some of that disgraceful behaviour.

Is there anything that can be done other than calling it out and making it absolutely plain that the inevitable consequence of such sort of abuse will be a diminution in the co-operation and assistance that’s given by people such as yourself?

Professor Sir Whitty: I think the main thing is to make sure that people who do this understand that their work is very thoroughly appreciated by the great majority of the population, which I think it is.

Lead Inquiry: Again, still at quite a high level, may I ask you to consider, please, the departmental Chief Scientific Adviser system to which you refer in your witness statement.

Is this the system under which, as my Lady has heard, each major government department has or should have in place a senior scientist to provide advice, to co-ordinate with other Chief Medical Officers across government in a cross-governmental way, to give advice to each department, and also to ensure that there is a consistency of approach across government?

Professor Sir Whitty: Yes. I think that most of the Chief Scientific Advisers, not absolutely all, are seconded in from academia, either part-time or full-time. The advantage of this is it brings some degree of independence, it brings some degree of external challenge, but it also brings in different expertise, and I think this was seen during Covid. So many of the Chief Scientific Advisers, were doing roles in the Covid response which were relevant to their particular skills, although it wasn’t the thing for which they had been brought in. So, for example, Professor Watts, in the Foreign, Commonwealth & Development Office, is a specialist in social – some aspects of social science, as well as mathematical sciences, she was very influential. Dame Angela McLean, now the Government Chief Scientific Adviser, was then at MoD, the defence department, but she was an academic epidemiologist and modeller of great reknown and so on. So people brought their personal skills alongside their departmental skills, and I think this was a very useful part of our response.

Lead Inquiry: Does the close working network between departmental Chief Scientific Advisers in each department allow for rapid transmission of technical information to each department?

Professor Sir Whitty: Yes, and it allows for a degree of essentially technical discussion between who know one another and then they can disseminate in their department in the way that is best suited for that department.

Lead Inquiry: Does the fact that Chief Scientific Advisers come from different professions and different parts of the scientific world assist in any way in the ability to challenge orthodoxy, to ensure that the thinking is sufficiently lateral and open to challenge?

Professor Sir Whitty: I think it helps, but I think we should all acknowledge that the wider you can go in terms of external challenge the better, because science works best when you have external challenge from multiple directions.

Lead Inquiry: Again, before we look at SAGE in detail, and again at quite a high level of generality, do you have any views as to whether or not there is sufficient diversity within the scientific world, in terms of the composition of these various committees and advisory groups, to ensure that essentially the advice that’s been given to government is sufficiently broad?

Professor Sir Whitty: Well, I think you’ve always got a tension: the more you broaden things out, the wider the range of experiences and skills and diversity of thinking you get, and the more unwieldy the committee becomes. I think what you’ve got to do is get a balance between those two. What you don’t want is everybody going round the table saying a single thing, no ability to challenge because it’s too big. So it’s getting the balance between those two, but I think on the whole the system works reasonable well. But, the big but is, of course, it also depends on an enormous amount of science underpinning it, and it should depend on people being able to challenge what’s said from the external environment as well, because that provides some of the additional challenge into the system.

Lead Inquiry: Turning then just to four of the particular groups to which you made reference in your witness statement. Firstly, NERVTAG, the New and Emerging Respiratory Virus Threats Advisory Group, of which my Lady has heard much in the last two weeks. Is this an expert committee, in fact, of the DHSC? Is it a committee which advises the Chief Medical Officer and, through you, ministers and the DHSC and other government departments in relation to, as it says on the tin, new and emerging respiratory viral threats?

Professor Sir Whitty: Correct.

Lead Inquiry: A point made by Professor Whitworth and Dr Hammer in their report, which I’m sure you’ve seen, is that one potential weakness with NERVTAG is, as it says, it only considers respiratory viruses and not the whole range of emerging infections. Is there a case for a tweak in the scope of any of these committees or groups, particularly NERVTAG, to ensure that nothing does fall between two stools?

Professor Sir Whitty: I think there is a potential weakness on this actually. As I laid out in my written witness statement, there are broadly five routes by which infections which could become epidemics or pandemics can go through. NERVTAG covers respiratory but it doesn’t cover the others, for example touch or sexual transmission. I mean, you’ve got to remember that the last very big pandemic we had affecting the UK was HIV, which is completely different, it’s a sexually transmitted, intravenously transmitted infection, completely different route of transmission, completely different disease.

There was a body called the National Expert Panel on New and Emerging Infections, bit of a mouthful, NEPNEI, which did have that wider role but that was, for reasons I’m not actually sure of, I wasn’t involved in this decision, stopped. I was previously chair of it so I knew its work, and –

Lead Inquiry: You knew it had stopped, presumably?

Professor Sir Whitty: No, I had ceased to be chair before it stopped, yes, and I think there is an argument for saying we need to cover these other areas because risks do come from multiple directions.

Lead Inquiry: Did NEPNEI provide expert advice directly to the CMO on the public health risks associated from new and emerging infections generally, so not respiratory viruses?

Professor Sir Whitty: That was their job.

Lead Inquiry: Was it in fact disbanded about ten years ago, does that sound about right?

Professor Sir Whitty: That’s about right, yeah.

Lead Inquiry: One of the points, going back to NERVTAG, made by a number of witnesses, in particular your colleague Professor Sir Jonathan Van-Tam, was that NERVTAG, because it is concerned with new and emerging respiratory viral threats, was in his view and – and is not in his view asked to predict threats that might emerge in the future, that there is obviously a lack of prospective examination because it’s not concerned with, on its – in terms of its terms of reference, with anything other than a present continuing emerging viral threat.

Is that a weakness in the scope?

Professor Sir Whitty: I think it – realistically the danger is you can end up with almost infinite numbers of theoretical threats. The sensible thing is to concentrate on threats which may look small at the moment but could expand very significantly, so, for example, MERS virus, another coronavirus, currently has relatively small numbers of cases every year, but it could expand very rapidly. We definitely need to have information about that, just to give an example.

I think thinking about theoretical ones is much more difficult, but you do need to understand the range – not you need to, but we all need to understand the range of possible scenarios, ranging from very, very high mortality, very low mortality, different routes of transmission, different forces of transmission, different age structures of disease, and that doesn’t – you can’t ask a single committee to cover all of that waterfront. What you do need to do is to allow for the possibility that they could come from almost any place.

Lead Inquiry: Does NERVTAG sit continuously or at least peripatetically, it sits from time to time, to consider constantly new and emerging threats, or does it respond to and act upon specific commissions from the government? So might a government department say of NERVTAG, “Could you please look at this particular issue”, or is it open to NERVTAG to raise of its own volition a matter which it believes is of concern or should be of concern to the government?

Professor Sir Whitty: So certainly – it’s certainly able to. I mean, when I’ve chaired scientific advisory committees or equivalents, my kind of view has always been about a 80/20 rule, which is if you spend all of your time considering things that only the committee is interested in and the government is not, then you’re probably not going to get much traction. Equally, if you’re only restricting yourself to the things which the government has raised, you may be missing either important things which the experts spot or, occasionally, issues which are inconvenient to government but need to be aired.

So I think that most of the time should be spent on things the government is asked about but a significant minority should be spent on things the government has not asked about, for whatever reason.

Lead Inquiry: Is the drawing of that difficult dividing line a matter that should, in your view, be left to the expertise and good sense of the members of the group as opposed to the application of some sort of prescriptive system?

Professor Sir Whitty: Yes, I mean, the number that I made was a made-up number but I’m illustrating the kind of rough divisions I think there should be. This really should be in the hands of the independent chair. They’re selected to be one of the experts in the country, they’re usually a very senior academic, and they can discuss with the secretariat and say, “This is what I want to do”, but my view is there should be some latitude, otherwise the committees can become the creatures of government, which is not the right approach.

Lead Inquiry: Professor Whitworth and Dr Hammer referred to a second group, the Human Animal Infections and Risk Surveillance group, HAIRS, which is a multi-agency cross-government horizon scanning and risk assessment group with, I think, a number of representatives from across government on it.

Is its scope, despite the fact – well, as it says, animal infections, it considers only potentially zoonotic infections, that is to say animal infections, and not the whole range of emerging infections?

Professor Sir Whitty: That is correct. But there is a very large overlap, in fact, but again it starts from zoo – it starts from animal diseases and works out which of those have zoonotic potential, that is to say have the potential to jump from animals to humans. That’s really what its principal aim is. It’s got a slightly wider aim but that’s its principal aim.

Lead Inquiry: But there is no question, is there, of there being a gap between two stools? Whether or not the infection is zoonotic or otherwise, there is in existence a group or committee which will be looking at the issue of an emerging threat?

Sir Chris, could I – I apologise – just ask you to keep your answers – to make your answers a little bit slower. Whilst, if I may say so, your evidence is wonderfully clear, it’s very difficult to transcribe.

Professor Sir Whitty: My enthusiasm is running away with me.

Lead Inquiry: So my question is whether or not an emerging threat is zoonotic or not, there is at least in existence a committee or a group that will be keeping its eye firmly fixed on the nature of the emerging threat?

Professor Sir Whitty: There should be, yes.

Lead Inquiry: Right.

The last committee I wanted to ask you about is the Advisory Committee on Dangerous Pathogens, ACDP. This is a DHSC committee. To what extent does that committee, concerned as it is with dangerous pathogens, overlap with those committees that deal with zoonotic and other emerging infections?

Professor Sir Whitty: So that committee, which I very briefly chaired, again when I was outside government, when I – sorry – is principally aimed at infections we know about and which, if they were introduced into a laboratory, for example, could be a risk to the people who are dealing with it, or could be a risk to people in hospital or people who come into contact with someone. They tend to be the diseases that have got very high mortality, so something like Ebola where, untreated, maybe 70% of people who catch it would die. So those very high consequence infections will be the most common, but a variety of other infections which have to be handled particularly carefully in terms of either their clinical or their laboratory management.

Lead Inquiry: So, standing back, is it your view that the broad range of advice compendiously provided by the various groups and committees is right: there is no significant issue in relation to omission or too great a degree of overlap or of ministers in the government not receiving the advice, in a general sense, that it requires?

Professor Sir Whitty: I think that in terms of identifying risks I think that the waterfront is quite well covered. There are some gaps which – but they are not huge ones, in my view. I think in terms of what the response should be, I think that’s a much more – I’m much less certain that that is covered well by the current system.

Lead Inquiry: Let us then look at that, please. Are you in fact really referring to SAGE, to which you referred earlier, which is the primary response body stood up, to use that phrase, in the event of an emergency to provide, of course, scientific advice on emergencies?

Professor Sir Whitty: If I may just go back one step from that.

Lead Inquiry: Please.

Professor Sir Whitty: 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.

Lead Inquiry: The issue of how to inject radicalism or, to put it another way, how to challenge groupthink effectively, or to put it another way, to increase the diversity of view in a committee, is a different issue, is it not, to the question of whether or not structurally this is an important and valuable committee to have?

Professor Sir Whitty: Yes, exactly, and my point is simply I think the system is very good at what it does, but we should recognise that there is a gap in the system.

Lead Inquiry: Could we look firstly, then, at the structure and then we’ll return, please, to the groupthink issue or the radicalism issue.

You have vast experience of SAGE, because you attended SAGE in your previous life as an interim governmental Chief Scientific Adviser, also as a departmental Chief Scientific Adviser, and of course now currently as the CMO, and I think as an observer for DfID when you were the Chief Scientific Adviser there.

Does SAGE sit permanently, or is it brought together in the event of an emergency?

Professor Sir Whitty: So SAGE is brought together only in an emergency. The way in which it’s brought together has changed over the last decade. So it used to be that it would only meet if it was asked to by Cabinet Office because COBR mechanism, which you were hearing about in your last session, was brought together. That’s changed now, and that changed actually as a result of the Ebola crisis in West Africa. We recognised that SAGE had to be possible to bring together irrespective of whether a COBR had been called if something looked big enough to need multi-departmental and multi-scientific views.

It’s called by the Government Chief Scientific Adviser – I know you’re hearing from Sir Patrick Vallance later – but it also can be requested by other Government Chief Scientific Advisers, in terms of departmental scientific advisers or the CMO.

Lead Inquiry: Because it’s convened by the governmental Chief Scientific Adviser, does that person also chair SAGE in all eventualities but not in the event of a health emergency?

Professor Sir Whitty: The Government Chief Scientific Adviser will always either chair or co-chair SAGE. If you have a SAGE, it means you’ve got a very big problem, and therefore that would clearly be a priority for the Government Chief Scientific Adviser of the day, and they might have to delegate it from time to time, but that would be the principle.

For health emergencies, there’s usually an assumption that the Chief Medical Officer would co-chair, and in previous emergencies I have co-chaired with previous GCSAs where it was seen that my expertise was such that that would be helpful.

Lead Inquiry: In the event of a health emergency, as of course Covid was, you therefore chaired SAGE along with Sir Patrick Vallance?

Professor Sir Whitty: Yes. I mean, I think that realistically he chaired most of the time, he is an excellent chair, but I was the co-chair and would stand in for him and would agree the agenda and sign off the minutes.

Lead Inquiry: The benefit, of course, of having the Chief Medical Officer co-chair SAGE in a health emergency is that the Chief Medical Officer will bring his or her medical, clinical, epidemiological experience, whatever it may be, to the table.

To what extent can SAGE call upon the expertise of experts outside the membership of SAGE? So, for example, from some of the other committees and groups to which we’ve referred, or individual experts and scientists outwith any of those groups.

Professor Sir Whitty: So SAGE is set up to answer the problem that it was actually originally – you know, if, for example, you have a volcano, you will bring in the best volcano experts from the UK, and potentially internationally if that’s the right thing to do. For the Covid emergency this involved many scientists who were on the expert groups but it also involved other people who were not on those groups but were seen to have national or international expertise.

The membership shifts. There’s no permanent membership of SAGE. The only person who is permanent in SAGE is the chair, the Government Chief Scientific Adviser. The other members are entirely to deal with the problems that are in front of the committee. This is to make sure you’ve got the right people in the room but not a large group of people, making it impossible to get to final decisions.

Lead Inquiry: If, Sir Christopher, the membership shifts per SAGE and if SAGE has the ability to call upon the experience of individual members of that committee with vast professional scientific experience and it can call upon the expertise of the various other committees to which you have referred and it may call upon the advice and assistance of individual experts, why is there an issue about the diversity of opinion or the absence of perhaps sufficient challenge or the absence of necessary radicalism?

Professor Sir Whitty: Well, I think I would – here I’d like to clearly separate between during an emergency and the period leading up to an emergency.

Lead Inquiry: Right.

Professor Sir Whitty: Actually my view was during an emergency the SAGE mechanism stood up as essentially the conductor of the orchestra. You’ve got around that lots of expert committees and, feeding into them, many, many scientists, the major academies and so on. So the mechanism can be fast-moving and it can pull science from multiple directions. I actually think it works pretty well. I don’t really think, despite what a few people have said, that there was any weakness in the radicalism or change in opinion of SAGE once the emergency was under way. I think where things have – and I’m happy to go through details of this – where I think there is an issue is between emergencies there is no SAGE and therefore what you have is large numbers of expert committees doing a perfectly good job on their own, but what you don’t have is an overall structure and the only situation in which they would end up in a radical place, in my view, is if they were challenged, usually by political leaders, who said, “This is a very big problem, I want you to think really widely about this”.

Lead Inquiry: Or perhaps by an external body or agency or resilience institute or whatever it might be?

Professor Sir Whitty: Possibly, but let us take, and I think I’m going to give a longer answer, because I think this is so central to all the evidence you’ve had so far.

Lead Inquiry: Sir Christopher, could I interrupt you very rudely to say, given the importance of the answer, please keep it as slow as you can make it.

Professor Sir Whitty: I apologise.

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. A very radical thing to do.

Lead Inquiry: Mandatory quarantine?

Professor Sir Whitty: 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.

Lead Inquiry: Of course Module 2 will return to the issue of the merits of mandatory quarantining, and I emphasise that’s a very helpful introduction to the topic, but we really can’t go further into that now.

Coming back to the central point that you make, which is that between emergencies because there is an absence of common aim, a common imperative to address all aspects of the instant emergency, there is a risk that all the various committees will fail to address sufficiently or think deeply enough about the possible ramifications or the consequences or the steps that have to be taken in relation to a prospective future emergency.

Professor Sir Whitty: That is –

Lead Inquiry: That is the point about mandatory quarantine?

Professor Sir Whitty: That is exactly right. If I could just add one important rider to that. The idea that the UK alone is thinking about this of course is incorrect. This is an international scientific effort and the situation we found ourselves going into Covid, the UK was in the middle, in my view, of the mainstream of world scientific opinion, so it wasn’t that we were, on our own, isolated in a particular position, we had a position that was identical to virtually all other nations I’m aware of.

Lead Inquiry: We’ll return to this issue later, but you are aware, of course, of – although it was before your time as CMO – Exercise Alice, which was the MERS-related exercise. My Lady has heard evidence that amongst the many recommendations and learnings from Exercise Alice were actions relating to the development of a MERS coronavirus, a MERS-CoV serology assay procedure for scaling up capacity, the production of a briefing paper on the South Korean outbreak concerning MERS with details of how to deal with port of entry screening, option plans for using evidence and cost-benefits for quarantine versus self-isolation, so mandatory quarantining/lockdowns versus self-isolation, and the development of plans for community sampling and also for mass contact tracing.

So all those issues to which you’ve referred, Sir Christopher, were all potential ramifications or consequences of a future prospective emergency as at 2016, but they were all flagged up in one way or another – admittedly not in the highest profile way – in 2016 as a result of Exercise Alice.

So why were they not taken further within or perhaps outwith the various committees which were constantly sitting to consider such issues?

Professor Sir 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.

Lead Inquiry: MERS is, as it says on the tin, a coronavirus. There was undoubtedly debate about these important steps, important plans, important policies. Were they not – let me start again.

If they were not pursued further or at least to full fruition and put into place by way of planning for a pandemic, was that because it wasn’t sufficiently recognised that a high-consequence infectious disease, perhaps a viral disease, could have the necessary characteristics and variables that would make it into a full-blown pandemic like an influenza pandemic, or because, administratively, the processes and the workstreams were simply not pursued sufficiently by the government, or both?

Professor Sir Whitty: I wasn’t involved in any of the decisions around this, I think I simply just can’t answer that in a useful way.

Lead Inquiry: All right.

You’ve given evidence about the need for diversity and radicalism and challenge in relation to the standing committee and group structures, but we deliberately don’t come on to SAGE, the response body.

Without going too far into the issue, because it is for Module 2, but to close off this matter, is there an issue about the diversity of composition of contribution in SAGE in the context of a health emergency? So, to be blunt, is there an issue – which I’m not asking you to resolve today – for future consideration about whether or not the outstanding experts, professionals and scientists who were on the committee were sufficiently diverse themselves, perhaps too weighted towards biomedical expertise as opposed to economic and social?

Professor Sir Whitty: Well, I think that wraps up several quite important issues. Can I take it as two different chunks?

Lead Inquiry: Please.

Professor Sir Whitty: The first is the issue about: was there enough diversity in the group? I mean, you know, if you ask that in an objective way, the answer, to almost any group, will be no. But in terms of what is manageable, given that you have to have a committee that covers as much of the ground as possible and has to move very fast – so just in Covid, we often had to have a meeting that finished half an hour before the COBR meeting or an equivalent, so you have to be able to do things quickly – there is – my view is it is a reasonable balance between coherence and challenge.

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.

Lead Inquiry: 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?

Professor Sir Whitty: 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.

Lead Inquiry: Right.

Professor Sir Whitty: So –

Lead Inquiry: You had a second part –

Professor Sir Whitty: 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.

The very, very narrow bit where I think that SAGE in the health emergencies can have a role is in health economics, which is a very specific bit of microeconomics which is generally in medical schools, and alongside them rather than to one side. Doctors know how to understand health economics, but that’s – the big macroeconomic questions, the fiscal questions which were central to the debates not just in Covid but in most other emergencies I’ve seen, that requires a completely different skill set, and I don’t think SAGE people, including myself, have the competence to assure government that they’ve considered the economic problem and they can now give a central view on it. I think that would have to be done separately.

Lead Inquiry: May I say thank you very much, because that is obviously of great assistance in terms of alerting us to some of the issues which will need to be explored in greater detail in module 2 in the context of the actual response by SAGE to the particular emergency.

Can I then come on to the issue of planning assumptions and the issue of the 2011 pandemic influenza strategy – of course, again, before your time as CMO – and some of the doctrinal thinking which has been open to criticism by a number of witnesses, both in writing and orally before the Inquiry.

The 2011 United Kingdom Influenza Pandemic Preparedness Strategy, you yourself say in your witness statement that in November 2018 it was recognised that there was a need to refresh that strategy and the work was to be led by the DHSC with oversight from the Chief Medical Officer and the Deputy Chief Medical Officer. But the work on the update ceased in March 2019 as a result of reasons with which the Inquiry is now very familiar, namely the reallocation of necessary resources or the necessary reallocation of resources towards EU exit preparations.

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?

Professor Sir Whitty: 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.

Lead Inquiry: That’s a point, of course, which has been put to those who actually are responsible for the drafting of the strategy within the DHSC and the Cabinet Office.

On the first point that you make, Sir Christopher, does it follow that even had the refresh been – and again I baulk at using the word – carried through, it wouldn’t have led to a significant difference in the United Kingdom’s ability to prepare for the pandemic that in fact ensued, because it wouldn’t have led to the necessary radical change of thinking that would have had a practical impact on our preparedness arrangements?

Professor Sir Whitty: That is my view.

Lead Inquiry: Right.

Can we come, then, to the doctrinal flaw to which you’ve just referred in that strategy, the one that might not have been picked up in any event, even had there been a refresh.

Would you agree with the following propositions: firstly, that there was in that strategy and generally across government a long-standing bias in behaviour of influenza?

Professor Sir Whitty: So I – that statement is true for good reason. I don’t think that means that other things were not considered. The reason for this is simply that we’ve had many more influenza pandemics, anyone who was born after 1950 will have lived through three of them, and therefore we do have to think about influenza separately. I do actually think that is – in terms of predictable risks, it’s the biggest single predictable risk. But what most people think is the most likely thing is something we have not predicted, what WHO calls Disease X. And it’s thinking around the ability to respond to the unexpected, the unpredicted, that I think that the separate strand of thinking needs to occur.

Lead Inquiry: I think the phrase comes from your predecessor, Professor Dame Sally Davies, that there is a long-standing bias. Bias is a state of fact or is a state of affairs. It may well be that there was good reason for that state of affairs insofar as the policy and the guidance and the strategy correctly recognised other risks, it just happened to determine that they were of lesser probability or lesser likelihood, and therefore they received less attention. But there was, was there not, administratively, a general taking of the eye off the ball in terms of focusing on those other risks, less probable, less likely, as they were, and a general trend towards focusing on influenza, disproportionately to the – with the consequence that other areas, other risks, other matters, were not sufficiently catered for?

Professor Sir Whitty: 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.

Lead Inquiry: The question was predicated in fact on this aspect, that was there a tendency administratively to become overly focused on influenza, so in fact it wasn’t designed to elicit the answer that there was a bias in terms of your or the expert thinking in this area, but the system and preparedness as a system began to display a long-standing bias, as Professor Dame Sally Davies says in favour of influenza?

Professor Sir Whitty: I think that is true, but I think this goes back to a general point which I think has been made by a lot of witnesses, that 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?

Lead Inquiry: That brings me on to the doctrinal issues – well, the flaws, strategic flaws 2 and 3.

In the plans, but most notably the risk assessment procedures and policies, was there, in your view, a failure to appreciate properly, firstly, that because of the variables inherent in any respiratory viral disease outbreak, such as levels of transmission, high, or stuttering, or transmission rate, whether short or long incubation periods, whether or not the virus would be asymptomatic or not, there was a failure to appreciate the risk sufficiently of a less likely but no less catastrophic pathogenic outbreak? The plans simply didn’t openly address such issues, transmission, incubation period, symptomatic infection.

Professor Sir Whitty: I don’t think it was – essentially my view is there are two separate issues that were missing. The first, in a way, the one that I think we really absolutely should have done, taken much more seriously, was the capability to scale up. That is useful in virtually everything. The ability – you know, every pandemic, every epidemic, the ability to diagnose, for example, is essential, and we had a very good capacity to do a very small amount of diagnosis really quickly and we did not have the ability to scale up, and I could repeat that across multiple other domains.

Lead Inquiry: I’m going to bring you back, most importantly, to this issue of scaling up and capability?

Professor Sir Whitty: Okay, fine, but just to lodge that I think that is very important. Then I think there was a strong intellectual appreciation that you could have multiple other conditions, and if you’d asked any of the excellent public health experts in UKHSA and PHE, as it then was, what are all the different things that could happen, most of them would have said there’s a very wide range.

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 –

Lead Inquiry: Well, you have just made plain, because it was a mild influenza pandemic?

Professor Sir Whitty: 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.

Lead Inquiry: But, Sir Christopher, your answer, of course, refers quite understandably to capability, to the need to scale up and of course to that foundational doctrinal observation which is that any plan for a pandemic must be able to cater flexibly for unexpected consequences or unexpected pandemics, and obviously mandatory quarantining doesn’t always work, it all depends on the nature of transmission of the pathogenic outbreak.

But my questions were designed to ask you about whether or not there was a failure in the planning, in the risk assessment process, the actual systems that we have in place in this country to deal with a pandemic, the planning, the EPRR structures. There was no open or extensive consideration of these issues, about transmission and the variable – inherently variable aspects of a pandemic or – asymptomatic infection or high transmission rates turning a high-consequence infectious disease into a full blown global pandemic, they’re just not apparent on the face of all this planning documentation.

Professor Sir Whitty: I think this illustrates a failure in the way we generally operate in government to deal with emergencies, which is to say we need to have a plan for every eventuality and if you can just pull off the plan, you can tick off all the things you’ve got to do, that’s going to work. Problem is – and pandemics is just one example, but a very, very extreme one, Covid demonstrated this – actually what nature is going to give you, to talk about the hazards – and threats are different, hazards – is going to be completely different every time.

So what you need to have is the building blocks of lots of different capabilities and you need to say, “Actually, we don’t know what problem we’re going to face, but what we do know is we’ve got the capabilities to face a whole range of different possible outcomes”. I think it’s this – the system design is designed to focus in on a plan based around a scenario rather than to, say, multiple capabilities that can be flexed to almost any emergency in biological or a geophysical or whatever space.

Lead Inquiry: But, thirdly, there does now need to be, and there is now, a consideration of multiple scenarios in a way which there wasn’t formerly in all this planning material following the Royal Academy of Engineering review in particular, which with which you’re familiar, which specifically recommended that for each risk a range of scenarios should be generated to explore uncertainty, and possible additional planning requirements. So it’s in essence the point you make: a proper plan must have within it the identification of a broader range of scenarios to alert the system that additional planning may be required and additional steps may need to be taken. That was the third strategic error, if you like, wasn’t it?

Professor Sir Whitty: Yes, in my view. Then I think I’d add to that a fourth, which is to expose really clearly to political leaders that there is a choice in terms of resource, and that: here is a one in 50-year event, do you wish to buy the insurance for that one in 50-year event, this is how much it’s going to cost.

I think that is really central to this, because I think the danger is we respond to a threat, a new perceived threat with a new plan, but no new resource, and that very seldom tends to end in a good way.

Lead Inquiry: May we park resource at the end of the list. That’s obviously a political issue.

Focusing – continuing to focus on the system, is a fourth strategic error that – and it’s one that I know you know that Mr Hancock particularly has made reference in his witness evidence to this Inquiry, is that because the reasonable worst-case scenario approach focused on the worst that could realistically happen, and because everyone’s minds were therefore focused on trying to deal with the worst that could realistically happen, insufficient thought was given to in, practice – until obviously Covid was upon you – trying to prevent the worst from happening at all?

Professor Sir Whitty: I half agree with the distinguished previous Secretary of State. 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?”

And actually it is senior ministers who have the capacity to say to the system: actually, are you absolutely right we can’t go any better than that? We need to actually address that.

So I think this is about the interaction between the political, “We’ve really got to do something serious here, I want to be absolutely assured we can’t do any better”, and the scientific and technical, “Okay, well, in response to that challenge, here is your range of options, but they are going to cost something”, and you need to understand what that trade-off is and then you can – and that I think is where we have not been successful.

Lady Hallett: Could we just pause, I’m afraid, Mr Keith. I think it may be that it’s been –

Mr Keith: Too much.

Lady Hallett: – quite a morning.

Mr Keith: I have out of the corner of my eye tried to keep an eye upon the travails of our wonderful stenographer.

The Witness: I apologise for my fast speaking.

Lady Hallett: Sir Chris, as a said to another witness, it’s a tendency I have too, so I understand. It’s very difficult to change your patterns of speech.

Can we break there?

Mr Keith: My Lady, may I just put one final thought to Sir Christopher?

Lady Hallett: Provided you speak slowly.

Mr Keith: I hope I speak a little slower.

Sir Christopher, you have then identified four broad, I would suggest, strategic errors or flaws in the system, none of these are personal, they are all of course to do with the way in which the system readied itself for a prospective pandemic. The fifth is a matter that you touched upon earlier and to which you made reference: was there a general strategic failure to learn from the experiences of certain East Asian countries who had dealt with SARS and MERS, and to learn from their responses to the particular characteristics of those coronaviral outbreaks, the learning to which you referred earlier of course relating to mass testing, mass contact tracing, mass self-isolation, and mandatory quarantine?

Professor Sir Whitty: Well, I think certainly if we’re talking about the pre-pandemic Covid period.

Lead Inquiry: Yes.

Professor Sir Whitty: I certainly think that we should do more to learn from approaches which are not the standard European, North American, if I can simplify, approaches to things which tend to dominate a lot of our thinking. So I certainly think we should be communicating as much as we can with other countries, including in South East Asia and East Asia which have outstandingly good scientists, who often come at things with a very different perspective. 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”.

Lead Inquiry: So the generic, the systemic improvements rather than specific countermeasures, for example?

Professor Sir Whitty: Yes, there are some exceptions, but broadly that is my view.

Mr Keith: All right.

My Lady, may we leave it there?

Lady Hallett: Certainly. Quarter to, please.

(12.46 pm)

(A short break)

(1.45 pm)

Lady Hallett: I’m sorry if there was some confusion about whether I was taking a short break or lunch.

Mr Keith: My Lady.

Professor, may we turn, please, now to the issue of maintaining capability.

In your witness statement, you make these points: that as soon as the danger of a pandemic or an epidemic has passed, it’s in the nature of things that countries start to dismantle whatever capacity they put into place, probably at great speed and under extreme pressure, and you make the further point that it’s simply not possible for any reasonable or proper system to maintain a full standing capacity to deal with a pandemic or prospective pandemic. But also that the risk of a future pandemic is an enduring one, it doesn’t go away.

So you make the concluding point that, in order to respond in a measured, reasonable, proportionate way to future challenges, there has to be the maintenance of some basic capability that must be scaled up in an emergency.

How is that line to be drawn? Where does one draw the line in terms of what those basic capacities are? How can any government have a clear understanding of what capacities it must keep by way of a minimum standing ability?

Professor Sir Whitty: Well, I think that there are, firstly, a group of technical capacities that we have to keep at a potentially quite low level, but we need to have them. So, for example, we must have people who are what’s called entomologists, who look at insect and other vector-borne diseases for humans. They happen rarely, except for things like Lyme, which happen not as an epidemic, but we need to have that capacity because were we to have such an outbreak in the UK, we need to be able to respond to it.

So there are specific skills we need to maintain across a whole range of the disciplines.

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.

Lead Inquiry: 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?

Professor Sir Whitty: 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.

Lead Inquiry: Of course.

Professor Sir Whitty: 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.

Lead Inquiry: The first of the two areas of which you have spoken, the technical disciplines, is it in fact the position that in this country we were blessed and remain blessed by the major scientific capacity, particularly in the area of infectious diseases, which exists? So in terms of the acknowledged experts in the field, the strong academic centres, the expertise in government, the technical capacity in Public Health England and the NHS, now UKHSA, and the basic applied research, our scientific structures were, as these things go, relatively strong?

Professor Sir Whitty: Yes, I think – I don’t think that’s a kind of jingoistic position. I think most international observers would say the UK scientific response, particularly on research but in other areas as well was very strongly by international standards. There are other areas people might be more critical of, but that, I think, is seen to be not perfect by any means but certainly strong by international standards. And it is essential that we keep that, to be clear.

Lead Inquiry: Was that evident at the time of the pandemic, or at least on the advent of the pandemic, by the speed with which diagnostic testing was able to be developed, by the various studies and the scientific work which was put into place, the SIREN study, the Vivaldi study in relation to care homes, the Covid-19 infection survey, the recovery trials in relation to dexamethasone and so on; on the scientific side of the response to the pandemic, the United Kingdom was in a relatively good position?

Professor Sir Whitty: Yes, that’s my judgment and I don’t think that’s a particularly controversial judgment.

Lead Inquiry: So the issue, then, for this Inquiry is the scaling up, the operational and necessarily the political decision-making which has to underpin it for the future?

Professor Sir Whitty: Exactly.

Lead Inquiry: Right.

Is it important, therefore, to state openly that, as a system, the country must maintain a strong and established clinical public health and biomedical research base so that in the event of the next pandemic that scientific support will continue to be available?

Professor Sir Whitty: That is absolutely my view, and I think people exaggerate the degree to which we can predict what the next threat will be, and therefore we need to have an ability to make a full spectrum response to a whole variety of different effects.

Lead Inquiry: That includes, therefore, scientific workforce, scientific research infrastructure, the flexibility, through studies, through proper scientific resource and so on, to be able to respond to the next pandemic?

Professor Sir Whitty: Exactly.

Lead Inquiry: All right.

Now, finally, just two aspects of your technical report, please. You’ve covered many of the areas in the course of your evidence, and I’m sure you – well, you’ve referred to your technical report already. I want to address two threads in the report.

One, firstly, why is data and the provision of data so important to preparedness?

Professor Sir Whitty: 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.

Lead Inquiry: As you observe, the Inquiry in Module 2 will be looking, of course, at the provision of data that was in place on the eve of the pandemic, and what was available to decision-makers when they responded particularly in February and March of 2020.

But the point goes beyond that. There had plainly been changes in the supply and provision of data in the United Kingdom. Undoubtedly government processes for the assembly of data have changed and improved as a result of the pandemic.

Is therefore the point to be taken that it is vital to ensure that those systems do not degrade in the future, that the higher levels at which data provision is being maintained now must be continued?

Professor Sir Whitty: So I think there are two elements to that. I completely agree with the basis of the question. The first is a technical one: do we actually have the ability to collect the data and then to knit it together from different directions to make an overall picture? That’s absolutely essential. That’s largely a resource and skillset question.

Then it is very important that we take the general public with us, whose data this is at the end of the day, to make sure that they feel comfortable that the way that we’ve brought data together to support decisions, to support medical science, is in line with what they would be expecting from their own data. I think those two have to be kept in balance.

But occasionally I think we have allowed ourselves to get overly concerned with the risks of this and therefore not make – not actually bring together data that would be hugely in the public interest to bring together, both to allow us to provide services now and to provide science that will improve public health and medicine in the future.

Lead Inquiry: A second, perhaps even more important, aspect of your technical report, because it comes in chapter 2, is the issue of disparities. Why are disparities in health relevant to the issue of preparedness?

The evidence, Sir Christopher, shows that the government systems on preparedness and the policy and the guidance and the structures paid absolutely no regard to disparities in health other than insofar as it was an obvious reflection of the fact that, clinically, some sectors of the population, because of comorbidities, would be worse off in the event of a pandemic.

Your report focuses to a very large extent on the need to ensure that disparities in health and in society are addressed. Why must they be addressed in the context of preparedness?

Professor Sir Whitty: One of the things that is striking and repeated in every pandemic and epidemic is that people living in areas of disparity suffer most from them. The reasons for that, however, vary. So, you know, the reasons that people in cholera epidemics died in higher numbers is because of the provision of poor water. The reason that people in some of the respiratory pandemics of history died was because they were in crowded housing conditions. And so on.

I’m making that point because you both need to think about disparity as a whole, but you also need to think about what the causal pathway is for each route of transmission and for each pandemic as it goes through.

But I think there is one final point I would like to make, which is the best way you can deal with reducing the risk of a pandemic to people living in areas of disparity or living with particular risks is to get on top of the pandemic. Essentially that is the most sure way of doing so, and I think we have to always remember that that’s the central plank on which everything else is based.

Lead Inquiry: Finally, in a particularly self-deprecating manner, Sir Oliver Letwin stated in evidence that politicians were in some significant regards amateurs, and that there was a case for training of ministers and officials in crisis management. Is there anything that you would like to say on that topic?

Professor Sir Whitty: 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 Sir Oliver, sparing his blushes because he’s not here, was a very good example of that. He did, in my view, a superb job, for example, during the West African Ebola crisis in knitting things together, absolutely picked up on all the issues.

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.

Lead Inquiry: Between emergencies, Sir Christopher, you are sadly prophets in your own land.

Professor Sir Whitty: I wouldn’t go that far.

Mr Keith: Thank you very much.

My Lady, there are a number of questions under Rule 10 from Covid-19 Bereaved Families for Justice Group.

Lady Hallett: Thank you.

Ms Munroe.

Questions From Ms Munroe KC

Ms Munroe: Thank you, my Lady.

Good afternoon, Sir Christopher. My name is Allison Munroe and I ask questions this afternoon on behalf of Covid-19 Bereaved Families for Justice. The questions arise out of a guidance document that you may or may not be familiar with.

Sir Mark Walport provided the Inquiry with a draft guidance for SAGE on emerging infections, diseases, which was produced between 2013 and 2017.

Perhaps if we could bring that guidance up, please.

It’s INQ000142139. Thank you.

If we go to page 2, we can see there the contents of the document, and then at page 3 – thank you – at page 3, the purpose.


“This document is intended to assist the Government Chief Scientific Adviser and the Scientific Advisory Group for Emergencies (SAGE) to provide timely, relevant scientific advice to the Cabinet Office Briefing Rooms (COBR) in the event of an emergency involving a non-influenza emerging or unidentified infectious disease which might affect the UK.”

Now, I don’t need to take you through the rest of that document for the purposes of the questions, but suffice to say, Sir Christopher, within that document there are definitions of risk, definitions of emergent infectious diseases and, at pages, for reference, 6, 7 and 8, the guidance sets out issues in terms of the impact or potential impact of emerging diseases on public or on civil society and on the economy.

First question, Sir Christopher – a rather long introduction – did you know about this guidance at the time that we’re concerned with in this Inquiry?

Professor Sir Whitty: I didn’t recall this guidance during the short period between becoming CMO and the outbreak of the pandemic, but I suspect I may well have contributed in a very – in several previous iterations in my role to the development of this draft guidance. I recognise kind of phrases I probably would have put into it. So I think I am aware broadly, but it’s a while since I’ve seen anything like this, and it’s not – I certainly hadn’t seen the final version. In fact I’m not sure there has been a final version of this.

Ms Munroe KC: Yes, because the authorship and the date of the document, I’ve said, between 2013 and 2017, so, as you said, there are a number of different versions of it, perhaps, iterations of it?

Professor Sir Whitty: There were two sorts of document, if I can just clarify.

Ms Munroe KC: Please.

Professor Sir Whitty: There were documents like this, which were to help guide the SAGE process and make it rapidly respond to a problem, and then when I was an interim – just interim Government Chief Scientific Adviser between Sir Mark Walport, who you heard from yesterday, and Sir Patrick Vallance, who you will hear from subsequently, I helped to add to that something we call golden hour documents, which were documents which allowed someone to deal with the bones of a problem even before SAGE had met, where you actually look at the key issues scientifically so you can actually inform discussions with ministers.

Ms Munroe KC: Yes, because in the guidance, and again we don’t need to take you to the document or have it up on the screen, but pages 8, 9 and 10 set out a series of questions for COBR and certain responses or advice that could and should be given.

Are you able to tell us, then, Sir Christopher, in terms of this particular guidance, how would it have been used by yourself and what considerations to this guidance would you have given, particularly in terms of informing any pandemic planning and educating frontline workers in health or social care, for example?

Professor Sir Whitty: So this document, to be clear, had a pretty narrow specific purpose and this was to help guide the set-up for a SAGE were there to be an emergency in this situation. So it was not designed for frontline workers. It wasn’t, in fact, designed to have a wider utility. This kind of document was, very narrowly, to help the Government Office for Science to have the most focused and effective first few SAGE meetings.

This would be particularly important if the Government Chief Scientific Adviser, for example, was working in an area outside his or her own area of expertise. I think the more they’re in their area of expertise, the more they would have felt comfortable, in a sense, setting the agenda themselves.

Ms Munroe KC: But as a guidance document, as its name suggests, it provides you with some advice and perhaps almost a starting point for further discussion and further thinking?

Professor Sir Whitty: Exactly, it’s designed as guidance, but guidance to guide the SAGE meeting, not guidance for the wider generality.

Ms Munroe KC: You’ve mentioned the golden hour documents. Again, turning back to Sir Mark Walport, who said of this draft guidance that it morphed into the current set of golden hour documents used by GO-Science.

Firstly, can you just explain what that is, when you talk about it and when Sir Mark talks about the golden hour documents?

Professor Sir Whitty: So the slightly clumsy phrasing actually, unfortunately, is from me, because it comes from sort of classic medical emergency procedures, where you say there is a golden hour in which you can intervene very rapidly and in that time you can have a very big impact. The lacuna, the gap that I perceived and others perceived was there was a period between the point an emergency arose and a point a SAGE had met, when a Government Chief Scientific Adviser, departmental Chief Scientific Adviser, CMO or whatever, would be asked legitimate and important questions by political leaders and others, to which they would have to give answers at that time, but in advance of the SAGE.

So the idea of it was to give basically a kind of crash course in a subject, let us say a major earthquake, so that someone could actually go to their first meetings with some degree of confidence that they had the various areas covered.

Ms Munroe KC: Thank you.

In addition, how were these golden hour documents used within your specific role as Chief Medical Officer? Is there anything else that you want to say about that and how you would use it?

Professor Sir Whitty: No, except I think to pay tribute to the SAGE secretariat from GO-Science who not only managed the SAGE meetings, but essentially provided the horizon scanning and the apparatus that underpins what the Government Chief Scientific Adviser can do in an emergency, particularly in the earliest stages.

Ms Munroe KC: Thank you.

Sir Christopher, my next question is about emerging infectious diseases. Am I right in saying that high-consequence infectious diseases fall within the emerging infectious disease category on the National Risk Register? So, for example, Ebola, SARS, MERS, avian flu are all examples of high-consequence infectious diseases, HCIDs?

Professor Sir Whitty: Some high-consequence infectious diseases are emerging diseases, a few are not, and many emerging diseases are not high-consequence infectious diseases, so they’re not synonymous, but there is a lot of overlap in some of the more severe ones like the ones you mention.

Ms Munroe KC: So my question is this, Sir Christopher, in the guidance, and this is at page 5, it says that an emerging infectious disease could potentially become pandemic, and that must be correct, mustn’t it?

Professor Sir Whitty: Very rarely.

Ms Munroe KC: Very rarely. The author then goes on, or authors rather go on at page 6 of the guidance to outline, firstly, the most likely scenario and then the reasonable worst-case scenario.

If we could perhaps have the document back up and go to page 6 to look at what’s actually said there.


Ms Munroe KC: So just looking at that box at the top of page 6, Sir Christopher, are you familiar with what’s written there?

Professor Sir Whitty: I am.

Ms Munroe KC: Yes. So they’re starting – again, it’s a starting point for thinking and discussion in this document, looking at scenarios and what potential action could potentially be taken, and also looking at behavioural aspects as well.

So you would accept, would you not, that in relation to emerging infectious diseases such as SARS, or a SARS-like disease, that was the “most likely scenario”?

Professor Sir Whitty: Within the narrow, narrowish definition of emerging infectious diseases that were important enough that they could have an impact on UK. That’s a lot of caveats. Because – but in that environment, something like SARS would be a very good example. But if I can – just to explain why I’ve made that distinction, another emerging infectious disease of very considerable significance was Zika virus. We considered this roughly over this time period. We thought this was a very serious emerging infectious disease but because the mosquito species that could pass this on are not able to maintain themselves for long periods in the UK, at least at this point in time, we thought this was a significant risk globally, in this particular case in Brazil, and this was in an Olympic year, but it was not a significant risk in the UK, nor was it likely to become so.

It is quite important when you look at a risk or a hazard that you make a judgment: is this a risk or a hazard in one place or is this a risk or a hazard that’s likely to come to the UK? This was an example where actually the risk or – the risk in this case was not likely to come to the UK and we made an important professional judgment we did not need to go beyond a certain point in our planning on this because that would have been inappropriate given the relatively low risk, in fact almost zero risk, of a significant epidemic of this infection in the UK.

Ms Munroe KC: Well, my final question is about where the emphasis lay in UK planning. And just to put this in context, with HCIDs there would need to be, in terms of the response, an enhanced response?

Professor Sir Whitty: There needs to be quite a specific response which notice – is based on the fact that these infections can have a very significant mortality if someone catches them, in terms of high numbers.

Ms Munroe KC: In your evidence earlier this afternoon, it was just after 12.30, I think, you were discussing the long-standing bias for pandemic flu planning, and you said:

“I think that’s true, having documents and plans are separate things, you need to have capabilities backed up by resources with capabilities to scale up.”

Now, with HCIDs, and I think this again, hopefully you’ll agree with this, in terms of airborne HCIDs and responding to them, there have been some exercises such as an Ebola exercise, wasn’t there?

Professor Sir Whitty: Yes, I mean, Ebola, just to be clear, is actually a touch-based disease, it’s not airborne or respiratory by route. That’s an important point. So were I sitting next to someone who had Ebola, I would be much less concerned than if it was an airborne or respiratory infection.

Ms Munroe KC: Well, as an HCID –

Professor Sir Whitty: It is an HCID, yes.

Ms Munroe KC: So there was an Ebola preparedness surge capacity exercise, wasn’t there?

Professor Sir Whitty: If you tell me so, I’m sure that is true. I can’t recall it but I’m sure that is true.

Ms Munroe KC: Again, we don’t need to bring it up, but for reference it is in the documents at INQ000090428.

The outcome of that surge capacity exercise for this HCID showed that there wasn’t, in fact, capacity to surge, it was a small amount of five cases, which would result in the loss of 80 infectious beds. So even on a small scale, for HCIDs, it was going to be difficult, wasn’t it, to scale up and –

Professor Sir Whitty: So the way that I would conceptualise this, if I may, is that you have two extremely specialist centres in the UK, one in London, one in Newcastle, which can manage the most infectious and dangerous cases, including diseases we may never have come across before. Around that there is a larger group of centres that are specialist in HCIDs which are, in a sense, still dealing with very high risk infections but are a slightly lower level of risk. But if you ran out of beds with the first two, then you would move into the next area round. Then around that are a group of specialist infectious disease – what’s called negative pressure rooms, where the air is sucked into the room, and that’s a much larger number but these are still specialist beds. Then around that is side rooms which are not specialist or don’t have the right equipment.

What you would do in an emergency is essentially you go out from the centre. If you had an HCID that was expanding in numbers, at a certain point you’d then move into what’s called cohorting, where you take over an entire ward – and we did this during Covid – and you say everyone on this ward is going to have this disease and no one who hasn’t got this disease goes on to this ward.

So there is a kind of – there’s a mechanism for scaling out. Each one of those is at a slightly lower level of expertise and at a slightly lower level of protection, potentially, maybe the first two are very high levels of expertise, but in all of those cases you always have to see there is an opportunity to scale. This is one of the things we have come back to repeatedly: you have to have plans to scale and you have to work out how you’re going to do it.

Lady Hallett: We’re going to have to leave it there, I am afraid, Ms Munroe, we’ve got an awful lot to get through this afternoon.

Ms Munroe: My Lady, yes, I think, in fact, Sir Christopher has answered my last question, about scaling out, yes.

Lady Hallett: Thank you very much.

Ms Munroe: Thank you very much, my Lady.

Thank you, Sir Christopher.

Mr Keith: My Lady, that concludes the evidence of Sir Christopher Whitty.

Lady Hallett: Thank you very much indeed, Sir Christopher, extremely grateful for your help.

I was astonished and sorry to hear about the abuse of you and other colleagues. It’s wrong for so many reasons, but I do know how distressing it can be, so I hope that people will think twice, but of course they never do, do they, before –

The Witness: Thank you, my Lady.

Lady Hallett: – committing themselves to distressing acts unnecessarily. There are so many different ways to express different opinions, why do we have to have personal abuse?

The Witness: Thank you.

Lady Hallett: Thank you so much.

The Witness: Thank you very much.

(The witness withdrew)

Lady Hallett: Ms Blackwell.

Ms Blackwell: My Lady, may I call Sir Patrick Vallance, please.

Sir Patrick Vallance


Questions From Counsel to the Inquiry

Ms Blackwell: Thank you very much, Sir Patrick.

And thank you for all of the assistance that you’ve so far given to this Inquiry, and for agreeing to come and give evidence today. I know that you will be called to give evidence later on as well, and you know, as we have made clear, the permutations and the limits of the evidence that we’re going to ask you to give today. Our timescale runs back ten years from the onset of the pandemic, and so I’m not going to ask you about decisions that were taken during the course of the outbreak.

Please speak up, please speak slowly, and speak into the microphones so that the stenographer can hear you for the transcript.

I’m going to begin by setting out your qualifications and career history so far as it’s relevant to this Inquiry.

You trained as a medical doctor and practised as a general physician in the NHS in various hospitals in London, and you undertook research in cardiovascular disease first at St George’s Hospital Medical School and later at University College London, where you were appointed first as a senior lecturer and then professor of clinical pharmacology and medicine in 1995.

You led the Division of Medicine at UCL from 2002 to 2006, and during your time you were a consultant physician at the UCL hospitals.

From 2006 until 2018 you worked for GlaxoSmithKline initially as global head of drug discovery, and from 2012 as global head of research and development, where you oversaw the discovery and development of many medicines, including antibiotics, anti-HIV drugs, cancer treatments and drugs for asthma.

You are an elected fellow of the Royal College of Physicians, the Academy of Medical Sciences and the Royal Society, and an honorary fellow of the Royal Academy of Engineering.

From April of 2018 until March of this year you held the post of Government Chief Scientific Adviser.

It’s really, Sir Patrick, in that role that we want your assistance at this stage in the Inquiry.

One of the benefits of giving evidence after Sir Mark Walport and the last witness, Professor Sir Chris Whitty, is that a lot of the explanatory evidence of your role as Government Chief Scientific Adviser, and indeed explanatory evidence of some of the scientific advisory groups, has already been received by my Lady, but I would like to touch upon some common features of the evidence that both of those witnesses have recently given.

In terms of your role as Government Chief Scientific Adviser, can you tell us, please, Sir Patrick, what you feel you brought to the role, any changes that you made, improvements that were brought to bear during your time in that role, and also tell us how you saw your role fitting in with the departmental scientific advisers and whether or not that part of the system is something that could be improved?

Sir Patrick Vallance: Well, thank you very much, and I’m very grateful to be given the opportunity to contribute to this Inquiry, which is obviously important for the future resilience of the country.

When I came to the role, I took advice, before I came to it, from a number of people, and I came to the conclusion that getting the science system in government truly embedded as part of government in an everyday sense was important. In other words, it shouldn’t be something that sits off to one side that you just turn to when you think you’ve got a specific scientific problem, but it should be that science actually is embedded in everyday thinking and policymaking, and therefore having high quality science advice systems would be a crucial part of that.

Part of that links to the need for every department to have a Chief Scientific Adviser.

Counsel Inquiry: Yes.

Sir Patrick Vallance: Those advisers sit in departments, they need to be part of the everyday activity and the policy and operational discussions taking place in those departments, so that they can bring in science and science advice to areas which perhaps a policymaker who’s not from a scientific background wouldn’t even think that science technology, innovation or engineering might have a part to play.

So one of the things that I set out to do was to look at the science capability across government and improve that system, at the initial suggestion and in discussion I had with Sir Jeremy Heywood, who was then the Cabinet Secretary. That project was undertaken with the Treasury and it was called a Science Capability Review, or Realising our ambition through science, and the idea was to try and get more structure into the system so that we moved away from individual scientists being able to contribute if somebody happened to ask them to one where actually there was an established process and system to allow advice to be given on a regular basis.

So I think part of my approach came from the fact that I had run a very big organisation across the world and therefore worried about things like making these things systematic.

Counsel Inquiry: You brought that into force in November of 2019, didn’t you?

Sir Patrick Vallance: Yes, that was when the report was published.

Counsel Inquiry: Right.

I suppose a connected issue would be the danger of – and this is relevant, I think, not only to the scientific advisers within departments, but also members of some of the scientific advisory groups, which we’re going to come on to in a moment – the danger of people moving positions and losing the experience and the knowledge from those positions.

How do you say that the best way is to capture that and to maintain that level of knowledge within the roles?

Sir Patrick Vallance: It is a very big problem in government, people moving around and experience and knowledge being lost, and ensuring that you have proper departmental structural systems for institutional knowledge management is important, and to make sure that institutional memory can be captured.

So one of the things that we spent quite a lot of time on is trying to make sure that that institutional memory is in place, that there are mechanisms that don’t rely on particular individuals in order for this to happen.

Counsel Inquiry: Yes.

Sir Patrick Vallance: As an example, which – it may be a trivial example but it’s an important one, I think, are things like papers. It’s one thing to have a paper that has a date when it was created, it’s quite a different one to say, actually I have a paper which it says when this paper has to be reviewed.

Counsel Inquiry: Right.

Sir Patrick Vallance: I think that’s really, really important that have dates by which you say, “This must have been reviewed by whatever, otherwise it’s no longer a valid document”. So I think there are process things like that which need to be in place in order to ensure institutional memory and continuity.

Counsel Inquiry: We’ll come on to it in a moment, but you will be aware of the evidence given this morning by Sir Chris Whitty about the UK Influenza Pandemic Preparedness Strategy 2011 which was not given any sort of refresh or review in the time that passed between its implementation and the pandemic hitting and the fact that, in Sir Chris Whitty’s view, it didn’t need a refresh, it needed an overhaul, that perhaps if that document had had within it a date by which it had to be properly and fundamentally reviewed, then that might have happened?

Sir Patrick Vallance: Well, it seems to me that is good practice, to, if you like, have a sell-by date on these things by which you must have looked at it and – and you can’t just roll it over, you have to have taken an action to have looked at it and say, “I agree this is still extant”, or, “No, this needs to be changed”.

Counsel Inquiry: Thank you.

One of the issues we discussed with Sir Mark Walport yesterday was the important difference between scientific advice, policy advice and political decision-making, and the fact that the role of a Government Chief Scientific Adviser is not to provide policy advice or to make decisions but to give the scientific advice that is requested.

Is there an important distinction between those three aspects of the roles?

Sir Patrick Vallance: Very important. And I don’t think it’s just to give the science advice that’s been requested, it’s also the science advice that needs to be given, because if you just wait to be asked it again goes back to the paradigm that assumes that the people asking know what the science advice needs to be.

So I think science advice is to pull evidence together, and by the way evidence of course changes. The whole nature of science is that it is continuously changing and updating itself and it is self-correcting. So one of the very important differences between what happens in science, where scientists actually quite like it when they discover that something they thought before was true isn’t true, or isn’t exactly as they thought it was, that is an exciting thing, that of course is not universally liked in other parts of the world, it’s often seen as a U-turn.

Counsel Inquiry: Or in other professions, I was thinking about the legal profession, actually, yes.

Sir Patrick Vallance: Well, I can’t comment on that.

So I think science advice is about bringing the evidence together and I’ve laid out four things that I think are important. Is the evidence base adequate? And if not what are you going to do about it?

The second is: has the evidence base and your advice been understood including the uncertainties associated with it and what might change those uncertainties. That’s a very important part of this, because those uncertainties would change.

The third, and I think this is often misunderstood particularly outside government, is: has the advice – is the evidence being presented in a way that’s relevant to policy? Because as a scientist you might often be very excited by your latest discovery, it doesn’t mean it’s relevant to policies. You have to frame things in a way that is sensible and usable by policymakers.

The fourth, which I think is often forgotten, is: can the science be used to monitor the effects of any policy choice? The policy choice is not the end of the process, it should then be monitored to see whether it’s having the effect that you thought it might have.

Counsel Inquiry: One issue that Sir Mark raised yesterday in his evidence, and he described it as a two-way street, is the fact that traditionally perhaps, or historically, there has not been as much – “interaction” is perhaps not the best word to use, but there hasn’t been an appetite on behalf of the scientists to raise matters which have not been requested by the government department. So there has been a reactive rather than a proactive involvement on behalf of the scientific advisory groups.

Do you recognise that and, if that is a problem, how do we, going forwards, ensure that the scientists are confident enough to raise things off their own bat?

Sir Patrick Vallance: Well, I read some of the witness statements from some of the committees –

Counsel Inquiry: Yes.

Sir Patrick Vallance: – these are all Department of Health committees, and it’s worth remembering that the GCSA role goes across every department, in every area of science, so it’s not – it just happens that I’m a doctor, it’s not that the GCSA role is a medical one, or, indeed, has any particular focus on DHSC, but I read those comments and I saw that in some of the committees they were in fully response mode according to the witness statements. I don’t think that’s correct. I completely concur with what Chris said, and actually if you look at the code of practice for science advisory committees, which is a document that we submitted, it says clearly that it should be a mix of response mode, ie things that the department wishes to know, and things that the experts wish to say or wish to look at.

I think that is important and it’s one of the reasons why, if we turn to the Chief Scientific Advisers or indeed the GCSA role, they are fixed-term, relatively short, so three plus two for a Chief Scientific Adviser, five for a GCSA, and they come from outside government, because you’re bringing an outside-in perspective, and it’s not a sort of long-term career plan to be part of it, so you don’t have the same sorts of pressures and career requirements and decisions that a civil servant might normally have.

I think that is important because it is about challenge as well as support and information provision.

Counsel Inquiry: Thank you.

Staying for a moment on the topic of improvements, you told us in your witness statement, paragraph 49, that you desired a high level of transparency in terms of, in particular, the workings of SAGE, and tell us, please, Sir Patrick, why you think that’s important and how we can ensure that that is something that’s taken forwards?

Sir Patrick Vallance: Well, I believe that science advice in government, particularly reports, I don’t mean every single discussion that’s taken place, but scientific reports and outputs should be made public. I think that’s beneficial for everybody. It’s beneficial for policymakers actually. It’s often not seen as that, but it is beneficial, because it means the evidence base on which a policy is going to be formed is there for scrutiny, is there for comment, is there for challenge, and actually is often there for people to say: okay, I get that now, I can see why you’ve made that policy choice, given the evidence that you have.

So I think the science advice should be public, by default. There will be times when ministers need a reasonable length of time to consider it as they’re formulating policy. That is a reasonable and fair thing. But I think in principle the science advice, unless it’s national security related, should become public.

I think one of the things we learnt early during the pandemic – prior to the pandemic the minutes and output from SAGE only were published at the end of the process of SAGE activation, and quite early on I was keen to try and get the papers out as soon as we could. It took longer than it should have done for that to happen, and that is, I think, a regret, and one that if you have the processes sorted out in advance should not be a problem in the future. In other words, you should get those papers out as quickly as you can.

It’s part of normal scientific practice and it’s the way in which science progresses, which is for other people to look at it and say, “Ah, you might have got that a little bit wrong”, or, “That may be a little bit different”.

Counsel Inquiry: What needs to happen, then, in order for going forwards the – well, is it a change of policy or is it a change of thinking, or is it the fact that somebody simply needs to write down a series of rules which are followed in the event of another pandemic? What needs to change?

Sir Patrick Vallance: Two things, and the first is the rules need to be laid out and that’s been done.

Counsel Inquiry: That has been done?

Sir Patrick Vallance: That principle of the SAGE papers will be published as soon as possible, particularly the minutes. The papers are a bit more complicated because they come from academics and others who have control over those, so putting a timeline on that is a bit more difficult, and what you don’t want to do, in my opinion, is to say, “Everything you give us is going to be in the public domain in 24 hours”, because they then won’t give you anything until it’s 100% complete, and that would be a mistake.

Counsel Inquiry: Yes, understandably.

Sir Patrick Vallance: So I think that’s one thing, and the second is the Government Office for Science needed to have a process for getting papers out on to the website, properly searchable and constructed, and that’s been sorted out. So I think both problems, actually, I see no reason why this can’t be the norm going forward.

Counsel Inquiry: Thank you.

Sir Patrick Vallance: Except in national security situations.

Counsel Inquiry: Yes, of course, where different factors apply.

Sir Patrick Vallance: Yes.

Counsel Inquiry: Please could we have on screen the SAGE checkpoint review which is at INQ000062443, and if we go to page 4, thank you, and could we highlight paragraph 22.

First of all, Sir Patrick, can you explain to us what the SAGE checkpoint review is?

Sir Patrick Vallance: This was the initial review that I asked for in early 2020, May 2020 –

Counsel Inquiry: Yes.

Sir Patrick Vallance: – from Sir Adrian Smith to come in and speak to a number of people in SAGE and other parts of government to try and find out what we were doing right, what we were doing wrong, and how we might change it as we were going along, recognising that we were in for a long haul on this and we wanted to get as much information and feedback as we could.

Counsel Inquiry: Thank you. We can see here “Science versus operational questions”:

“Across policy customers and SAGE participants, there was consensus that the line between science advice and advice on operational issues had sometimes become blurred. This led to SAGE sometimes being asked to advise on matters that were more operational in scope, for example, in relation to environmental transmission and the science behind mitigating risks.”

Now, I don’t want to ask you about what took place during the course of the pandemic, but just to ask you to explain whether, in your view, there is a problem about scientists being drawn into providing advice outside of their level of expertise and, if there is, how we can plan so that that doesn’t happen in the future?

Sir Patrick Vallance: So some scientists in government are there to provide operational science advice, and that’s particularly true in the public sector research establishments, and it would be true, for example, in what was Public Health England scientists, they are there to provide operational science advice and, indeed, to operationalise science, so that is entirely appropriate.

I think what’s important, though, is where it is advice, so it’s either from the Chief Scientific Adviser or from SAGE or from other committees, that the evidence and the advice is separated from the policy conclusions, which must be up to those who have to formulate policy to put in place.

There is a bit about training and understanding that needs to take place in that, and there’s also a bit about the recipient of that, because there were several occasions when people would want science advice on things that were simply not possible to give that science advice on because they were too granular, too specific, too detailed, and I think that’s a process of learning. It got better, actually, during the pandemic, and I don’t want to stray too much into what happened, but there was one thing which was important, which was an educational process of those commissioning science to try and help them understand what were appropriate science questions to ask and which ones just were not going to be answerable.

Counsel Inquiry: All right, thank you. We can take that down, please.

In terms of being better prepared, planning for both those risks which we are able to anticipate and those which we’re not able to anticipate, but having in place good systems, flexible systems that are able to cope with the unexpected, you talk at paragraph 46 in your witness statement of something called “rules of the road”. What do you mean by that and how can that help?

Sir Patrick Vallance: Well, the rules of the road concept came up during the production of the 100 Days Mission, which was a G7 project, and that was about trying to get vaccines, therapeutics and diagnostics in play within 100 days of identifying a potential pandemic threat being declared. I’ll come back to that perhaps later, but the point here is that we said, well, there are some things that you don’t need to wait and find out what the infection is or what the problem is before you can establish what you’re going to need to do.

So, for example, in the 100 Days Mission it was on things like sharing samples across borders, it was about sharing data without having to go and renegotiate at the beginning, it was about rapid finance mechanisms to allow things to be done quickly.

These things should swing into action immediately without having to worry about going through permissions and processes and devise things in the heat of the pandemic.

So the rules of the road concept is to identify the generic issues that you know are going to be there, they might be legal, they might be ethical, they might be political, they might be social, and just say: can we please clear those so that we can activate them immediately without having to then re-design it or negotiate in the middle of a pandemic.

Counsel Inquiry: All right. I know that my Lady has given provisional permission for Bereaved Families for Justice to ask questions on the issues of data and the topics of how that might be improved going towards, but in terms of data collection and data usage, is the rule of the road that certainly there can be procedures put in place now –

Sir Patrick Vallance: Yes.

Counsel Inquiry: – that are capable of being adapted to lots of different situations when they arise?

Sir Patrick Vallance: Yes, and I’ve argued, and I think it remains important, that for every risk on the national security risk register we should – government should go through and ask: what are the data that you know you’re going to need? Because it’s going to give you information. Who owns those data, or in other words where do they sit in the organisations? How might those flow somewhere in the state of an emergency and where do they flow? How do you make them interoperable and who is going to analyse them?

Those questions are simple questions that can actually be looked at in advance and will throw up, I think, blocks that we know exist and can be unblocked during non-emergency times, and it’s very true for pandemics and it’s equally true for other national risks as well, I believe.

Counsel Inquiry: Thank you.

What is your view of the interaction between your role and that of the scientific advisers within the devolved administrations? Is it historically a good relationship? Is it a close relationship? Can it be, in your opinion, improved at all?

Sir Patrick Vallance: Well, I have a very good relationship with the Chief Scientific Advisers in Scotland and Wales and increasingly now in Northern Ireland where they’ve now got somebody who is at least standing in for that role, and I work with the permanent secretaries of the devolved administrations to make sure that they know that they do need to have a Government Chief Scientific Adviser and have been on the appointments panels for those roles.

The system obviously is a bit different in the devolved administrations in that, unlike for the United Kingdom government, where we’ve got a Chief Scientific Adviser in every department, that’s not the case in the devolved administrations, but each – apart from Northern Ireland at the moment – does have an overall Government Chief Scientific Adviser, and that person is the one that I interact with most, for obvious reasons, because they have a job which covers the government more broadly in the devolved administrations, and I meet with them – or met with them, I should say, I’m no longer in post – met with them on a regular basis, as I did with departmental CSAs, and also we agreed it was useful to have a regular meeting of just the devolveds and me so we could talk about things that were specific to devolved administrations that we might pick up together as a group, and I think that’s – that worked pretty well actually in terms of day-to-day non-emergency situation for interacting with the chief advisers.

Counsel Inquiry: I suppose one of the benefits of that is that when something like the pandemic hits you have already forged relationships with those individuals and there is a level of trust amongst you which, were you not concentrating on making sure that there was joined-up thinking between all of the roles, then that relationship wouldn’t be there?

Sir Patrick Vallance: Personal relationships are always important in these things, and that was a crucial one to get right, and they also – and the thing I really like about the way that CSA network has evolved is that sub-groups spontaneously form, so they form to say: actually we now know we as a group of three or four need to go away and do a piece of work.

That’s what happened with the devolved administration Chief Scientific Advisers as well, they’ve done that and formed a group.

I think there is a specific question, and I know it’s come up in some of the witness statements, about not the overall Government Chief Scientific Advisers but the individual departmental Chief Scientific Advisers in the devolved administrations, particularly in health. And I have to say one of the unexpected consequences of getting a very functioning CSA network going is that everyone wants to join it, and not everybody can, because it will become overwhelmed, and the reason that we’ve stuck with a single Government Chief Scientific Adviser from each of the devolved administrations is (a) they are the people who then can connect their own CSAs in those nations and (b) it allows for, for example, the health CSAs from the four nations to join up as a group, and I believe they’ve now done that, they’ve joined up as a group. I think it would be inappropriate to start having all of those people in the overall scientific network, otherwise it’s going to become very skewed by health, and topics we discussed ranged from cyber security to climate to biodiversity to marine laws and so on. So, I mean, there are all sorts of areas which are far away from pandemics and health.

Counsel Inquiry: Thank you.

Before we move away to deal with the role of the Government Chief Scientific Adviser in relation to the national risk assessment, I just want to ask you about a final matter which I know you have a certain level of passion about, and that’s the prospect of an academic centre for pandemic preparedness.

Why do you think that that is a good idea?

Sir Patrick Vallance: Well, I think it’s very, very important that we have a thriving research base, and Sir Chris mentioned that in his evidence, and there’s something about bringing together a critical mass of people who are concerned with the same overall problem, of pandemic, which I think is going to provide the challenge and the independence and the foresight into the system. So I’m an enthusiastic proponent of the idea of creating a centre for pandemic preparedness.

There are many different models that people are looking at. Personally I would favour something that was a sort of hub and spoke model, where you had somewhere where there was a physical base but then you had many other universities involved, and that is a place where many different disciplines could then come together, and actually that is a place where I think things like economics could also be considered alongside epidemiology and other areas, because it would begin to provide an insight into how you might think about the sort of difficult trade-offs that occur there.

So I think concentrating on properly funded, well structured pandemic preparedness centre would be an advantageous thing for the UK and would be an important part of how you think about introducing really informed integrated challenge into the system.

Counsel Inquiry: Would that also have the capacity to soak up behavioural science, something along those lines? And as a connected question, do you think that behavioural science demands a place on a full-time advisory board? Because we know from the evidence of Sir Mark Walport yesterday that SPI-B was stood up for the pandemic but has since been stood down again.

Sir Patrick Vallance: A few things on this. First of all, I mean, any centre for pandemic preparedness shouldn’t just soak up behavioural science; behaviour and social science should be an absolutely integral part of it, and that’s the whole point, it should be a multidisciplinary thing. It’s not one where I think everyone is spending 100% of their time working on pandemics, and that’s the beauty of it, it would allow an academic who’s a specialist in one thing to say “I want 10% of my time to be spent in this”, and in doing so you would create a critical mass. So I think it’s fundamental.

I think it’s worth noting that I think every exercise that’s referred to in the documents had a behavioural scientist present at it.

Counsel Inquiry: Yes.

Sir Patrick Vallance: So there has been quite good representation.

SPI-B, which was set up, I believe, initially, as the name suggests, for pandemic influenza behavioural science, was set up by DHSC and stood down, and we reactivated it quickly during Covid. I’m not sure SPI-B is necessarily what you would have for ongoing behavioural science input to other things, and we recently within the last year set up a behavioural and social science for emergencies group, headed by one of the CSAs who is a social scientist, Jennifer Rubin, with the idea that that group would look across national emergencies and ask: what is the social science evidence base that’s likely to be required in different emergencies? How could you commission research to try and get that sorted out? And what needs to be done both inside and outside government to try and get that right?

So I strongly support the emergence of that group.

Counsel Inquiry: Thank you.

Lady Hallett: Ms Blackwell, I think if that’s convenient –

Ms Blackwell: Yes, of course.

Lady Hallett: – I think we’re getting signals.

Ms Blackwell: Right. Thank you. We’ll break then for …

Lady Hallett: We’ll be back at 3.05.

Ms Blackwell: Thank you, my Lady.

Lady Hallett: Sorry to break off, Sir Patrick.

(2.51 pm)

(A short break)

(3.05 pm)

Lady Hallett: Yes, Ms Blackwell.

Ms Blackwell: Thank you, my Lady.

Sir Patrick, what is the role of the Government Chief Scientific Adviser in relation to the creation of the national risk assessment, please?

Sir Patrick Vallance: So the national risk assessment is done department by department, so there’s a lead government department for each of the areas, and therefore the construction of the content is done inside a department and the challenge process for the specific risk is done inside the department.

The role of the Government Chief Scientific Adviser is to look across at the methodology and ask: are there some anomalies or things that need to be changed in order to get the appropriate consistency across? Or indeed other areas where we think that there’s a need for different types of approaches given different types of risk.

So maybe as an example – obviously my first experience of one of these was soon after I arrived, and most of it was in train by the time I arrived, but at the end of it, having pulled together the CSAs to say: are you all involved in what’s going on in your departments? Because they should be. Not all of them were, so I had to sort of make sure that they knew what was going on and they were actually linking in their – inside the department with the resilience teams, and then to pull together the CSAs to say, when we look across, are there things that that we’re now –


Counsel Inquiry: Sorry, Sir Patrick, please continue.

Sir Patrick Vallance: Are there things that we’re pulling up as anomalies or difficulties. So I think after the 2019 risk assessment I wrote to the Civil Contingencies Secretariat and said there are a few things that we picked up, one of them was reasonable worst-case scenarios, which we said there doesn’t seem to be a clear consistent way of doing this across departments, and I think what was needed was more of a sort of workshopping approach in departments to really stress test what they were putting forward as their reasonable worst-case scenarios.

A second –

Counsel Inquiry: I’m sorry to interrupt you. Is that the correspondence that you had with Katharine Hammond?

Sir Patrick Vallance: Yes. Yes, who was head of the CCS.

Counsel Inquiry: Yes, thank you very much. Sorry.

Sir Patrick Vallance: Sorry.

Counsel Inquiry: Please continue.

Sir Patrick Vallance: The second was around interdependencies and concurrent risks where we thought that looking at everything completely separately doesn’t allow you to look at that properly.

A third area was that we felt that there ought to be a way of not only looking at expert challenge, in a departmental sense, but then to look at expert challenge across the whole thing, and that might require external and different types of groups to do that, so we suggested that that could happen and the CSA network could help provide names and support that process.

The final thing was that I felt that ministers needed to really understand what risks it was that they were living with. You know, what was it that they were actually agreeing to when they did this.

Now, the process for actually approving the National Security Risk Assessment is through the National Security Council, and the National Security Council then goes to ministers and ministers sign it off. So that’s really the role of the GCSA, is that sort of methodological look-across to make sure that there are improvements.

That feedback led to the commissioning of the Royal Academy of Engineering to produce what I think is a very good report which outlines some areas that could definitely be improved on.

Counsel Inquiry: Yes. Just pausing and dealing with the report, that was commissioned in January of 2021.

Sir Patrick Vallance: Yes.

Counsel Inquiry: Within that report is a recommendation that a spectrum of scenarios are considered. We’ll come to that in a moment. But just remaining with the 2019 national risk assessment, the Inquiry has already heard evidence and looked at the assessment as it related to pandemic influenza, and the reasonable worst-case scenario involved up to 800,000 deaths.

My Lady, a very eagle-eyed member of the public has been in contact with the Inquiry to say that when I was examining the former Prime Minister David Cameron earlier this week, I referred to 800 deaths rather than 800,000 deaths, so can I please make it clear that it was 800,000 deaths. Thankfully, I don’t think it misled Mr Cameron –

Lady Hallett: It didn’t mislead me either.

Ms Blackwell: Good, I’m glad to hear that.

Sir Chris Whitty earlier today was asked about the potential problem with the reasonable worst-case scenario system, in that it encourages people to look at the situation once that reasonable worst-case scenario has happened, and ignores the prior stage of prevention.

Do you acknowledge that problem, and if it is a problem, what’s the solution?

Sir Patrick Vallance: I’m not sure – well, I absolutely acknowledge that that’s the reality, that there is less attention paid on that than there should be. I don’t know if it’s the reasonable worst-case scenario that makes that happen or not, I just can’t comment on that. But I do think, and that was in my letter to Katharine and, as I say, went to the foundation of why the academy of engineering was asked to look at this, was scenarios are important and looking at different approaches to the reasonable worst-case scenario is quite an important thing, because if you don’t have consistency – and it’s worth reflecting that, of course, the risk assessment process has a mixture of likelihood and impact –

Counsel Inquiry: Yes.

Sir Patrick Vallance: – which I think is problematic because you then multiply those two things to end up in a position, and the reason I think that’s difficult is that people then associate funding with where you end up on that.

Counsel Inquiry: How so?

Sir Patrick Vallance: Well, because the higher your joint score, the easier it is to use that as a lever to try and ask Treasury, therefore you need more funding. And that may not be an appropriate way to view this at all.

So I think impact is incredibly important, and I fully endorse the suggestion of the academy of engineering that impact is the thing that should be focused on. It’s worth knowing the likelihood, but in the end events are binary, they either happen or they don’t happen.

Counsel Inquiry: Yes. You will remember the evidence of Sir Mark Walport earlier this week who talked, I think, of – and also Sir Oliver Letwin – who spoke of the black swan event, that incident that is not particularly likely but when it happens it is catastrophic, and that those risks shouldn’t be missed?

Sir Patrick Vallance: I think that’s right. I mean, what you then do about those risks and how much effort and money you want to put on it is a ministerial decision.

Counsel Inquiry: Yes.

Sir Patrick Vallance: It’s important in that context, actually, that a lot of this – and I say this in my statement – there are some analogies with preparing for pandemic and other risk, but I’ll stick with pandemics, to the question of whether you want an army or not. You need an army in a country and you don’t turn round after 20 years and say, “What a waste of money that was, we haven’t had a war”. I think it’s the same thing. You know, which are the risks you want to make sure that you are properly enabled to deal with?

I agree with the point that Sir Chris made, this is about capabilities, it’s not about trying to end up with highly specific responses in the back pocket all ready for every single eventuality. That’s not possible. But there are generic capabilities which are important across the piece.

Counsel Inquiry: He spoke also of flexible capabilities backed up by resources so that, if necessary, scaling up is capable of happening at short notice?

Sir Patrick Vallance: I think scaling up is really, really important. And I want to raise a couple of points which I don’t think have been raised.

One is that industry is really important, and so one of the resilience features for a country is which industries you’ve got that will enable you to do it. So we were fortunate in some areas, such as vaccines and pharmaceuticals, that we’ve got a big sector that was able to contribute to the scaling up. I mean, making a vaccine isn’t just what you do in the laboratories, the ability to turn it into millions and millions of doses. We do not have a diagnostics industry of any scale in the UK, which made scaling up of diagnostics much more difficult. And Germany has a big diagnostics industry and did very well on that.

So I think as part of resilience planning it’s quite important to look at the question of industrial base in the country as well and ask what needs to be done to make sure that the industrial base is in a position and is properly linked into the processes and the relevant organisations.

Counsel Inquiry: In terms of vaccines, then, using that by way of an example, Dame Kate Bingham has expressed her concern that since the pandemic has slowed down and we’ve come out of the emergency phase, if I can use that expression, the vaccines taskforce has been stood down. Do you think that that is a problem? Do you think that there should be an ongoing capability in terms of vaccine production? And, if so, is that simply a political matter or is that something which science can help with?

Sir Patrick Vallance: Well, I started the vaccines taskforce and brought Kate in for a very specific reason, which is we had a very clear need to get things done in a very direct way, and she did it brilliantly. But that need was obviously not the same as the need now.

Counsel Inquiry: Yes.

Sir Patrick Vallance: So I don’t think that the model we set up for the vaccines taskforce in 2020 is one that you necessarily need now. But is there a need for a focus on vaccines for resilience? Absolutely.

So at the beginning of 2020, when we started looking at vaccines in January 2020, it was obvious that the industrial vaccine base in the UK had pretty much gone. There was still research but the industrial base.

I don’t think that was an active decision, it was what I’ll call benign neglect, with a very significant consequence. So that had to be reactivated quickly as a part of that.

I think the focus on vaccines then needs to be embedded in what you do in everyday practice, and this is part of the 100 Days Mission principle. Don’t dream that you can have a vaccine factory sitting there waiting for a pandemic. It’s going to be staffed by people who don’t know how to make vaccines. You need everyday activities that you can then scale quickly. That, I think, is a part of resilience that needs to be thought through very carefully: what are the everyday things?

So for diagnostics, if I take that as an example, the more the NHS use routine near patient rapid diagnostics, the more you have an industry, the more you’re able to scale that for pandemic preparedness.

Counsel Inquiry: Is it a political decision to ask: well, does the country want the insurance of having a standing capability in terms of the strong scientific advice that Sir Chris Whitty spoke of being incredibly good, by international standards, in terms of having a scalable vaccine development, in terms of other types of medical procedures and interventions that might be required in the event of a pandemic? Is that insurance policy something in your view, Sir Patrick, that really needs to be grappled with at a political level?

Sir Patrick Vallance: Yes, it’s a political question. And it’s an important one that also links to behaviours and culture, which I think Sir Oliver Letwin touched on.

If I give a very specific example, when we set up the vaccines taskforce, it was very, very possible, even likely, that it would fail, and at the end of it of course it was a great success and the National Audit Office wrote a report saying what a great success it was. If it had failed, the National Audit Office, I suspect, would have written a report saying what an outrageous waste of public money the whole thing was, and yet both things were totally possible. So there is an inherent reluctance to spend money in things which then might fail and look like a disastrous misuse of public money.

So I think we need to be much more explicit about why spending public money is important for certain things, even if that then turns out not to be what’s needed or used. In fact it’s picked up in the Hine report in relation to the 2009 pandemic as well.

Counsel Inquiry: I think it follows from the evidence that you’ve given to the Inquiry today that you would also agree with Sir Chris Whitty on this topic: that although it’s important to have up-to-date and relevant documents such as the Influenza Pandemic Preparedness Strategy, and perhaps even have a strategy along the same lines for emerging infectious diseases, documentation only takes you so far, and what has been set out by both of you about the flexible capabilities in practical aspects of preparedness is really where the importance lies?

Sir Patrick Vallance: Very, very important. I think Whitehall loves a report and a letter, and it’s about moving from that to a practical, “What’s the plan to actually do something about this?” Which is incredibly important. It requires ministerial oversight and drive to make things happen, and very often requires very clear single point of accountability, otherwise things get diffuse and don’t happen.

Counsel Inquiry: Yes, thank you.

Finally I would just like to ask you about the importance of identifying those with health inequalities in the planning and preparation for pandemics and the like. How can that best be done, given that, as Sir Chris Whitty explained earlier today, one has to perhaps consider the causal pathway of a pandemic to identify who it’s heading for most forcefully?

Sir Patrick Vallance: I mean, there is a terrible, terrible truth, and it’s something that we all need to reflect on, which is that all pandemics feed off inequality and drive inequality. I mean, that’s the way they behave. That is a tragedy that needs to be understood and is relevant, of course, to the many people who suffered during Covid. That needs to be built into the thinking, the thought process, right at the outset.

Of course the issues of inequality are very broad and highly political across all sorts of areas, but the fact is it is what drives problems in pandemics, and therefore one needs to be extremely aware of that at the beginning, and one of the things when I look back at the science advice – we did pick up on it but I would like it to be embedded right from day one, it needs to be one of those questions on the first SAGE, you know: what are the issues around inequality that you should be thinking about now? In terms of science advice. Others need to think about it in terms of operational planning.

It’s relevant also to your question about behavioural science. I mean, one of the big questions is around communication, engagement with marginalised communities, and that needs to be thought about in advance.

I hope it’s one of the things that the behavioural and social science group for emergencies will be thinking about now as they think about what research and other things can be put in place now that could help inform people.

Ms Blackwell: Thank you, Sir Patrick.

My Lady, as I have already indicated, provisional permission has been given to Covid-19 Bereaved Families for Justice to ask questions on the issue of data. May that be done, please?

Lady Hallett: Certainly. Thank you.

Ms Blackwell: Thank you.

Questions From Ms Stone

Ms Stone: Thank you, my Lady.

Good afternoon, Sir Patrick. I ask questions on behalf of Covid-19 Bereaved Families for Justice, which represents families across the UK.

As has already been prefigured, I want to ask you a few questions, if I may, about data, and I think I can take it shortly, because you have already touched on this in your evidence.

Sir Chris Whitty described the importance of data in this context this afternoon and I take it that you would agree with his characterisation of the importance of data? I can see that you’re nodding, Sir Patrick.

Sir Patrick Vallance: I mean, completely, and it’s in my statement –

Ms Stone: It is.

Sir Patrick Vallance: – as to how crucial it is.

Ms Stone: Would you agree that that importance that we’ve just agreed on of the data in pandemic response was something that was well known in the scientific community prior to Covid-19’s emergence?

Sir Patrick Vallance: Yeah, I don’t think you would have found anybody who’s said data is not going to be relevant –

Ms Stone: Yes.

Sir Patrick Vallance: – to any response. So I think, yes, data is important, and I think it’s well understood across government that data are important for decision-making.

Ms Stone: Yes.

Now, we understand from your statement, and again Sir Chris Whitty touched on this, that issues with data led to significant problems in the early stages of the pandemic, didn’t they?

Sir Patrick Vallance: There was a paucity of data, which meant – and I say that in my statement – that on many occasions it meant that you were flying more blind than you would wish to.

Ms Stone: Those are questions for another module, but the fundamental point is that being able to gather basic data, such as how many people are in hospital, how many people are in intensive care, that was necessary, wasn’t it, to understand the spread of the disease and to evaluate which individuals might be most at risk from the disease? Would you agree with that?

Sir Patrick Vallance: Yes.

Ms Stone: Now –

Sir Patrick Vallance: And just one other thing, if I may?

Ms Stone: Yes.

Sir Patrick Vallance: I think the ONS survey that we got in place was another way of doing that, and it would be very, very important to get those things set up early.

Ms Stone: Yes, and I think you say in your statement that systems were put in place during the course of the response to the pandemic but some of those had to be started from scratch, I think is the phrase that you use, and that’s clearly not the situation that anyone would wish for; would that be right?

Sir Patrick Vallance: Correct.

Ms Stone: Now, you’ve told us this afternoon, Sir Patrick, about the simple questions that, in your view, need to be asked about data. So just to recap, they are: what are the data we need? Who owns them? How can they be collected? How can they be shared? Are the systems for doing that sharing interoperable, so do they speak to one another? Who is going to analyse the data?

Have I summarised those accurately?

Sir Patrick Vallance: Yes.

Ms Stone: Thank you.

Now, could we describe that, those collection of questions, as a data strategy?

Sir Patrick Vallance: Very high level. I’m sure there are data experts who would want to add much more to that, but I think that in principle those are the components.

Ms Stone: Yes. As you’ve said, those are areas, each of those questions should be considered and resolved in advance of an emergency?

Sir Patrick Vallance: Yes.

Ms Stone: That strategy as I’ve called it, and perhaps you wouldn’t, but those collection of questions, that consideration of the importance of data, wasn’t in place before Covid-19 to address a pandemic, was it?

Sir Patrick Vallance: I don’t think it can have been, because that was not how it worked, and so I don’t think the practicalities – so it’s interesting, because I think if you’d asked people, “Is that what you need?” before the pandemic everyone would have said, “Yes, and I’m sure that’s fine”. The reality was it wasn’t fine and there weren’t systems that allowed that to happen. So practically, operationally, that was not in place.

Ms Stone: It should have been, shouldn’t it, Sir Patrick, given what was known about the importance of data in this context?

Sir Patrick Vallance: Well, I think it should have been for all sorts of reasons, including it’s very important for running healthcare systems and so on. So I think in general it was an important set. I think some of the interoperability with other datasets perhaps it wasn’t so obvious that that needed to be in place at the beginning, and perhaps there wasn’t the driving need to have that in place at the beginning, but I think the basic bits, yes, you would expect that to be in place.

Ms Stone: The core fundamental bits of health data –

Sir Patrick Vallance: Yes.

Ms Stone: – those should have been in place beforehand?

Sir Patrick Vallance: Yes.

Ms Stone: Just finally on this, Sir Patrick, if I may, you told us this afternoon, I think, that you’ve argued that these questions should be addressed for each risk on the National Risk Register; is that right?

Sir Patrick Vallance: Yes, I suggested to be practical that they should take the top ten or 15 and do it there to make sure that we knew how to do it and then work through the rest.

Ms Stone: Yes. Can you tell us what action was taken in respect of the argument that you made prior to you leaving your position?

Sir Patrick Vallance: Well, I know it’s been understood and that people accept that this is what needs to be done, there is now – something called the National Situation Centre has been put in place in central government, which is a big data centre to be able to analyse data and input data from many different sources, and there are data scientists in that group as well. So that is a very, very good start to this.

I also know that the chief statistician, Ian Diamond, and I spoke about this a lot, and he is looking at which data systems and flows can be used to get this right. So I think there is action against it in terms of a capability level. I don’t think it’s gone down to risk by risk yet.

Ms Stone: Yes. Thank you, Sir Patrick.

Thank you, my Lady.

Lady Hallett: Thank you very much.

Ms Blackwell: My Lady, that completes Sir Patrick Vallance’s evidence.

Lady Hallett: Thank you very much indeed, Sir Patrick, you have been extremely helpful, as indeed was obviously your close colleague, Sir Chris Whitty. Thank you both very much indeed.

The Witness: Thank you.

(The witness withdrew)

Ms Blackwell: My Lady, I’m being asked to invite you to take a five-minute break whilst we arrange things for the next witness, please.

Lady Hallett: Certainly. I’ll be back in five minutes.

Ms Blackwell: Thank you.

(3.30 pm)

(A short break)

(3.35 pm)

Ms Blackwell: My Lady, the next witness and indeed this week’s final witness is Dr Jim McMenamin. May he be sworn, please.


Ms Blackwell: Oh dear. I’m so sorry.

Lady Hallett: I don’t think you were meant to give evidence.

Ms Blackwell: Let’s try again.

Dr Jim McMenamin


Questions From Counsel to the Inquiry

Ms Blackwell: Thank you.

Dr McMenamin, thank you for the assistance that you have given to the Inquiry so far. You’ve provided a witness statement, and I know that you are familiar with the corporate witness statement as well from Public Health Scotland, and thank you for coming to give your evidence to the Inquiry today.

Please keep your voice up, speak into the microphone so that the stenographer can hear you for the transcript. If you need a break at any time, just ask.

I’m going to begin by setting out your career history so far as it’s relevant to the Inquiry.

You are a medical doctor with a master’s in public health and honorary clinical senior lecturer at the School of Health & Wellbeing at the University of Glasgow.

You were appointed as a consultant epidemiologist to the Scottish Centre for Infection and Environmental Health in 2003.

You were then interim clinical director and strategic lead for the respiratory viral team within HPS, and you are now the head of Infections Service and the strategic incident director for Covid-19 at Public Health Scotland.

Is that all right?

Dr Jim McMenamin: Thank you, and one extra thing, that I was the chair for the three years of the National Incident Management Team in Scotland.

Counsel Inquiry: Thank you. For the three years involving Covid-19?

Dr Jim McMenamin: That’s correct.

Counsel Inquiry: Thank you very much.

Well, it’s your evidence prior to that that we’re interested in today in Module 1, and I’m going to begin, if I may, by using you to set out the history and structure of Scotland’s public health bodies.

As you tell us in your statement, Dr McMenamin, Public Health Scotland works to protect and improve the health of people in Scotland and to reduce health inequalities. It became a legal entity on 7 December of 2019 and came into operation on 1 April 2020, and we’ll come back to that in a moment. But that means that in relation to the time to which this module relates, the national leadership for protecting the Scottish public from infectious diseases and environmental hazards was the remit of Health Protection Scotland, or HPS, which was part of the NHS National Services Scotland; is that right?

Dr Jim McMenamin: Yes, that’s correct.

Counsel Inquiry: HPS led on preparing for high-consequence infectious diseases, epidemics and pandemics, and National Services Scotland led on preparation for general civil emergencies and whole-system civil emergencies; is that right?

Dr Jim McMenamin: Yes, that’s correct.

Counsel Inquiry: Thank you.

You explain in your witness statement that Public Health Scotland brought together three legacy bodies, Health Protection Scotland, Information Services Division, and NHS Health Scotland; so taking those three bodies in turn, if we may.

HPS can trace its history back to 1969 and the creation of the Communicable Diseases (Scotland) Unit, which was a specialist unit tasked with conducting surveillance of communicable infections; is that right?

Dr Jim McMenamin: Yes.

Counsel Inquiry: Yes, and the Communicable Diseases (Scotland) Unit then evolved, absorbing and expanding its remit to include helping protect the public from non-infectious environmental threats to health, and at one point the unit was renamed the Scottish Centre for Infection and Environmental Health, and it then became Health Protection Scotland in 2005.

That’s a whistle-stop tour of the history of public health in Scotland.

But Health Protection Scotland was responsible for providing health information, together with the Information Services Division, and National Health Service Health Scotland was Scotland’s national health improvement agency.

We have additional information about this in the Public Health Scotland corporate statement, my Lady, explaining that the work of National Health Scotland focused on what could be done to improve public health in Scotland and to reduce what was seen as unfair and avoidable health inequalities.

Is that work still very much in progress?

Dr Jim McMenamin: Certainly very much so, it’s at the centre of everything that our organisation Public Health Scotland has been set up to address.

Counsel Inquiry: Thank you.

Public Health Scotland was created through the programme of public health reform that began, in 2015, with the public health review and, as we’ve already made mention, was delivered up to and including 2020 through the public health reform programme.

Are you able, please, Dr McMenamin, to explain why it was concluded that Public Health Scotland ought to be created and was created when that happened?

Dr Jim McMenamin: Thank you.

Over time there had certainly been a very significant number of infection challenges and information challenges in the community, from the perspective of inequalities. Earlier in proceedings we’ve heard testimony from experts on just what the impact has been of those inequalities.

The purposeful bringing together of the three organisations was to try and put inequalities at the centre of everything that we do, to improve healthy wellbeing in the population, and that that very purposeful attempt then was to bring together the relative strengths of each of those organisations to try and assist in that process. If you like, to have some synergy between each of those to make sure that nothing was falling between the stones.

Counsel Inquiry: So do you see there being a benefit of having a single unified public health agency?

Dr Jim McMenamin: Very much so.

Counsel Inquiry: What about the timing of it, Dr McMenamin? Why was Public Health Scotland made operational in April of 2020, given as we know that that was really a month or two after the Covid-19 pandemic had hit?

Dr Jim McMenamin: It’s certainly unfortunate timing, but nonetheless something which had been well scheduled and was very supported by all of the territorial NHS boards and the other boards in Scotland and by Scottish Government, and also by COSLA, because this new organisation was to be one in which it was jointly sponsored by the chief officers of each of the local authorities and by Scottish Government. So this signalled approach where we were going to be coming into being became part of the legal framework in December 2019, and then we came into being on that April 2020.

Counsel Inquiry: Right.

Dr Jim McMenamin: That was a smooth – as smooth as we could make it – transition where our NSS, National Services Scotland, colleagues assisted us all the way through and, as we became this new organisation, rather than the 100 or so people that we might have had at the start of this to try and deal with things, we now had access to more than 1,000 personnel to be able to help us in dealing with that.

Counsel Inquiry: So in terms of the timing of it, it was something that had been in the planning for several years.

You mentioned COSLA, that’s the Convention of Scottish Local Authorities, isn’t it? What was the rationale for and the effect of Public Health Scotland’s accountability to both national and local government?

Dr Jim McMenamin: Well, this again was a new bit of innovative thinking where we were trying to ensure that no matter what we did it was to enable the health of the population at a local level, to be best assisted within the combined efforts of the new organisation.

Counsel Inquiry: Right, thank you.

Some questions now about funding. You tell us in your witness statement that Public Health Scotland’s opening budget and staffing levels were, in your view, not sufficient for the organisation to be able to deliver health protection in a response that was required when the pandemic hit.

Does that remain your view, and explain to us, please, Dr McMenamin, why you hold that view?

Dr Jim McMenamin: Yes. In this instance, the particular thrust that we had here was that we had to have a funding that was adequate, but flexible. How do we make sure that any ringfencing that we have didn’t get in the way of what we needed to do within the new organisation? Now, I understand that financial rules and regulations are essential within our National Health Service organisation to make sure that we demonstrate value for money in everything that we do –

Counsel Inquiry: Yes.

Dr Jim McMenamin: – but nonetheless it becomes important that we’re able to have flexibility in how we can best utilise that funding available to us.

But there’s one important caveat to that, that for that funding – which was, you know, you will see from our statement submissions, was funding in a pre-pandemic setting – was something which was felt to be adequate for a pandemic as we move into that, that flexibility that we then would like to have is something which becomes much, much more attractive to allow a speed of response.

Counsel Inquiry: Yes. Thank you.

May we have on screen, please, INQ000101052. This is a document that we can see from the bottom right-hand corner was created in December of 2006, and it’s Health Protection Scotland’s health protection framework for the response to an influenza pandemic in Scotland.

We can see from the first two paragraphs that this is indeed a document devoted to pandemic influenza rather than any other type of pandemic.

Dr McMenamin, why did this framework focus only on influenza as opposed to any other type of pandemic, and how, if you can explain to us, did that in any way hamper the situation?

Dr Jim McMenamin: This document was produced before what has been called the swine flu pandemic of 2009.

Counsel Inquiry: Yes, 2009, yes.

Dr Jim McMenamin: It was, at the time, what we could say was the likeliest issue to come and challenge us. So from that perspective, it was very deliberately focused on a response to pandemic influenza in which we, on a UK basis, were working collaboratively to deal with that.

Counsel Inquiry: All right.

Let’s look, please, if we can at page 7 of this document, and we can see that the aims of the health protection framework is to provide a tactical framework for health protection response, to put the health protection framework for the response to an influenza pandemic in Scotland in the context of the overarching national arrangements laid out in the UK health departments’ influenza pandemic contingency plan, the Health Protection Agency pandemic influenza plan and the HPS emergency response plan.

Just pausing there, this of course pre-dated the United Kingdom influenza pandemic strategy which we know was created in 2011, and the Inquiry has heard from several sources that, despite certainly best efforts at a time close to the pandemic hitting, it was never updated.

Are you able to tell us whether this older document, created as it was in 2006, was ever updated to attempt to give more timely advice to Scotland on pandemic influenza?

Dr Jim McMenamin: Thank you.

It was never updated, but the reason why that was never updated was that, as you’ve outlined, we then had a pandemic of swine influenza. There was a UK discussion about how we would best learn the lessons and adopt recommendations from the learning lessons that we collectively had. That meant that there was a deliberate attempt to have a co-ordinated UK approach to how we deal with things.

Counsel Inquiry: Right.

Dr Jim McMenamin: And although at the time that we did ask our Scottish Government colleagues about whether they would like this to be revisited, the clear indication that we had at the time was that we would be using a UK approach to deal with this.

Counsel Inquiry: Right. So moving ahead from 2006, swine flu hits in 2009, the UK government commissioned the Hine review, which indeed led to the strategy being created in 2011. Once that was in place, did the UK strategy replace this older document, or did they sit alongside each other?

Dr Jim McMenamin: That’s right, it replaced things, because we were then working to a UK approach that was co-ordinated.

Counsel Inquiry: Thank you.

Can we take that down, please, and replace it with document INQ000147859, which is an interim report from the Health Protection Stocktake Working Group. We see that the date of that is July of 2011.

Do you know as a matter of fact whether or not this came into force before or after the UK strategy?

Dr Jim McMenamin: I’m not quite sure because of the relative dates of when things were produced. I can’t recall whether the reports were synchronous or not.

Counsel Inquiry: This was a working group established to examine the arrangements put in place in 2005, which I think had led to the 2006 strategy that we’ve just looked at, and to ensure that they were still fit for purpose; is that right?

Dr Jim McMenamin: Yes.

Counsel Inquiry: And this interim report contains a series of recommendations. Could we go to page 46, please. Thank you. We can move through this quite quickly, but the recommendations relate firstly to capacity and resilience – if we can scroll down, please – roles and responsibilities, priorities and outcomes, governance, and consistency. Thank you.

This was an interim report. The final report which we can put up, please, at INQ000147828. Thank you. Can we go to page 44, please. Thank you very much. It sets out – in fact can we go up to the previous page so that we can see what the columns … there we are.

On the left-hand side I think we have the recommendations set out, and then the next column along, going from left to right, we can see whether the recommendation has made it into the final report from the interim report.

At the bottom, at number 34, page 42, we can see:

“Interchange should be arranged between staff of HPS and NHS boards and other activities considered to strengthen relationships and engender mutual respect and to help soften existing boundaries. This should include a wide range of activities including joint learning sessions; joint training and web-based initiatives.”

If we move across we only see that that recommendation was in the interim report, but then in the right-hand column we have these words:

“MHPN, with the support of NHS boards and HPS …”

Can you explain to us firstly, if you know, why this recommendation didn’t make it into the final report, and what is meant by the bodies in the final column?

Dr Jim McMenamin: Perhaps in reverse order.

Counsel Inquiry: Okay.

Dr Jim McMenamin: The MHPN I guess here is a managed health protection network. What ultimately came out of that was the Scottish Health Protection Network, an obligant network of stakeholders coming together who were mutually working with each other, including local authorities, to ensure that we had addressed all of the challenges presented within health protection.

Counsel Inquiry: So Managed Health Protection Network, yes, and that – this tells us that that organisation was working with the support of the NHS boards and HPS.

So does that mean that, because those systems were already in place, that recommendation didn’t need to be taken forward to the final report? Is that how it worked?

Dr Jim McMenamin: Well, for many of these things, that we were taking them beyond that –

Counsel Inquiry: Right.

Dr Jim McMenamin: – because, as I just suggested, that local authorities were now to become part and parcel of what we were trying to do, to make sure that local delivery was addressed.

Counsel Inquiry: Thank you.

Can we go to page 44, please, and highlight the entry under “Roles and responsibilities”. Here we can see:

“There is a need to improve communication between HPS and NHS boards. Interchange should be arranged between staff in both directions, and other activities considered to strengthen relationships and engender mutual respect and to help soften existing boundaries. This should include a wide range of activities including joint learning sessions, joint training and web-based initiatives.”

We can see on the right-hand side the assessment is that:

“The [Managed Health Protection Network] is of course designed to help achieve a sense of integration between all parts of a service and should therefore be expected to serve a function of improving relationships and communication. However, our recommendation on interchange and other activities should stand.”

So this is how it appears in the table.

Is the impression being created, Dr McMenamin, that there was a difficulty perceived in terms of relationships between these bodies and, if so, how was that manifesting itself and what was the proposed solution in order to engender better relationships?

Dr Jim McMenamin: I think that the principal thing here that we were trying to address was a levelling up –

Counsel Inquiry: Right.

Dr Jim McMenamin: – to try and ensure that experience at a national level and at a local level was interchangeable, that we could then see and learn from each other. The Scottish Health Protection Network began to have that purpose by having that sharing of learning and experience across all of the health protection functions within Scotland.

Counsel Inquiry: And would you say that, following on from this final report, things did begin to improve?

Dr Jim McMenamin: I think that it’s certainly true that they were much improved as a consequence of the success of the Scottish Health Protection Network. That’s not to say there are not continuing issues that we have had further effort to try and overcome.

Counsel Inquiry: All right, thank you very much. We can take that down now.

Concentrating for a moment on the wider programme of health protection reform in Scotland, you tell us in your witness statement that the creation of Public Health Scotland was indeed part of a wider programme of public health reform, and you go on to note that HPS colleagues, yourself included, advocated throughout the reform period for recognition of the importance of actions to protect the public from outbreaks of communicable disease and incidents involving non-communicable environmental hazards to public health.

Why was HPS required to advocate in that way?

Dr Jim McMenamin: I can offer you two potential answers to that, one which is a corporate one, and perhaps one a personal one.

Counsel Inquiry: Well, please do.

Dr Jim McMenamin: So from a corporate perspective, I think that what was important here was that we were trying to ensure that there was health protection having its place at a table when the key objectives that were then listed were not immediately ones that jumped out saying health protection was at the centre of things. We had a further discussion on an ongoing basis about this, and that health protection we were assured was at the centre of everything that we were doing.

On a personal note, that I can see that, yes, that was important that we continued to advocate for clinical and scientific leadership for health protection being important because we were mindful of the importance of instance outbreaks and, regrettably, pandemics.

Counsel Inquiry: All right, thank you.

May we look briefly, please, at INQ000102990, because moving forwards – thank you very much – this is the 2015 review of public health in Scotland. It was, as we can see, strengthening the function and refocusing action for a healthier Scotland, it had as its basis.

Can you provide a summary of this document, please? We can see that at the bottom, although it’s headed 2015, it was actually produced finally in February of 2016.

Dr Jim McMenamin: Yes.

Counsel Inquiry: Tell us what this is about, please, Dr McMenamin.

Dr Jim McMenamin: So here, and coming back to our central rationale for what we were trying to do, it was important that we were trying to put health inequalities at the centre of everything that we were doing. You’ve heard already testimony from Bambra and Marmot about the stalling in life expectancy as one indicator of the health of the population. This was then occurring against this backdrop where we were very aware of the need to try and come together to address those health inequalities and hopefully to then have an increase in the healthy life expectancy of individuals.

Counsel Inquiry: All right.

Was there anything within this review about the involvement of public health in terms of laboratories?

Dr Jim McMenamin: Yes, this is – and it’s important, I think, here that there is an important distinction that I have to offer about what you may have already heard in testimony about, for the Health Protection Agency –

Counsel Inquiry: Yes.

Dr Jim McMenamin: – for Public Health England, and then the UK Health Security Agency. Unlike the situation for all of those successor organisations, Public Health Scotland’s role in the laboratory services management was in a commissioning role only.

Counsel Inquiry: Right.

Dr Jim McMenamin: So our opportunity then to have a great effort and discourse about that was certainly not something that was addressed in the main by this kind of document.

Counsel Inquiry: What role did HPS, and then later PHS, play in commissioning national microbiological reference laboratories? What role did it play?

Dr Jim McMenamin: So right up until the end of the time period for which we are discussing, this pre-pandemic –

Counsel Inquiry: Yes.

Dr Jim McMenamin: – period, our role was limited in the main to this commissioning role for the national laboratories that would be doing reference work. That’s unlike the situation then where much of the routine work might be offered through either a combination of UKHSA laboratories in England and the NHS service laboratories.

Counsel Inquiry: Is it correct that the sponsors, the Scottish Government and the Convention of Scottish Local Authorities, or COSLA, were engaged in developing an annual operation plan for PHS?

Dr Jim McMenamin: Yes, and we’ve continued – and I know it goes beyond the timeframe of the examination today –

Counsel Inquiry: Yes.

Dr Jim McMenamin: – but we’re certainly very much encouraged by the ongoing work which has developed following on from the beginning of the pandemic, and that we are currently involved in for some of the commissioning work, going beyond that into what is the needs assessment that we have for laboratory services across all of Scotland.

Counsel Inquiry: Thank you.

I would like to ask you now about the provision of expert advice to the Scottish and the United Kingdom government and the extent of HPS’s involvement in scientific advisory groups such as NERVTAG and SAGE.

What was the role of the Scottish public health service in the NERVTAG advisory group? Was it a member, to start off with?

Dr Jim McMenamin: So NERVTAG – and I’m sure that you’ve heard already quite a bit about this – is an organisation which has been set up which has taken through a robust appointment process experts in individual areas. It just so happens that I was successful in application to that on a personal basis –

Counsel Inquiry: Right.

Dr Jim McMenamin: – rather than it being Public Health Scotland which are represented –

Counsel Inquiry: Yes.

Dr Jim McMenamin: – at that type of meeting.

Counsel Inquiry: Right, okay. And were there other representatives from other devolved nations also present when you were there?

Dr Jim McMenamin: At its inception – and it’s changed over time – then it’s certainly been important to have opportunity for other colleagues to be co-opted into that process, and Professor Peter Horby in the most recent past then has been instrumental in trying to ensure that, dependent on the setting that we’re considering, that there’s an appropriate scientific representation across the whole of the country.

Counsel Inquiry: Right.

In terms of the subject matter that NERVTAG considered during your time there, do you have a view as to whether or not that was more limited than it might have been? And, if it was, were there other aspects that you think as an organisation, as an advisory group, they would have benefitted from including in the matters that they considered and discussed?

Dr Jim McMenamin: Yeah, I’m very much struck by both the testimony that I’ve heard from witnesses here but also from looking at the witness statements that have been provided both by Wendy Barclay and by Peter Horby.

Counsel Inquiry: Yes.

Dr Jim McMenamin: They give a good account, I think, of, that there is always this balance, a balance about: we have set questions that we’re trying to address, because the government of the day have key things that they would like us to address, but that the scientific curiosity of many of these individuals in the same room is extraordinary, that these experts are often bringing complex issues that they have noted would be important for the group to begin to consider, and there’s opportunity through that network to then encourage one or other of the administrations or the Department of Health to then put that down as a significant item for discussion at a next meeting.

Counsel Inquiry: Yes. You may be aware of the evidence given earlier today by Sir Chris Whitty on this subject; he landed on an arbitrary percentage of 80/20.

Dr Jim McMenamin: 80/20.

Counsel Inquiry: Yes. But that, I think, accords with the evidence that you’ve just given –

Dr Jim McMenamin: Yes.

Counsel Inquiry: – that there needs to be a two-way street, which is another phrase taken from Sir Mark Walport’s evidence.

Dr Jim McMenamin: Absolutely. I don’t quite know what the percentage is, and as an epidemiologist you’d probably get an hour discourse from me about that. But, yes, I agree.

Counsel Inquiry: All right, thank you very much.

We know from your witness statement that you also sat on SAGE representing HPS, as it then was, PHS as is now is, and tell us about your time there, please, Dr McMenamin, and whether you think that there are improvements that can be made in terms of the way that that advisory group conducts itself.

Dr Jim McMenamin: My time as an observer in all of the proceedings, getting to as many of those as I possibly could, along with many colleagues, was it was an extraordinary examination, forensically at times, of the key challenges presented of the day. Those individuals who were coming, who were giving of their time freely, were truly incredible and I have nothing but respect for everything that they were able to say and do.

My role there was limited, perhaps, if there were key things that we were providing either as validation of observations that were occurring south of the border or in the other administrations, or for the first time being able to present interesting observations, particularly in the early days of the estimation of vaccine effectiveness, where we were able to say, using the EVE collaboration data that had been set up as a consequence of the hibernation projects set up after the swine flu pandemic, important observations there about early insight to what we might see in the population, an early light of a path potentially out of the lockdowns and social restrictions that we had in the population.

Counsel Inquiry: Whilst you were present at SAGE meetings, were you convinced that there were mechanisms in place to promote challenge and to ensure a range of views, as we’ve just discussed is so important in these advisory groups?

Dr Jim McMenamin: Yeah, I think that all of the SAGE meetings were ably led by either of Sir Patrick Vallance or Chris Whitty or others who might be deputising on the day. There were great opportunities for colleagues to be able to say without reservation what their own views were about particular challenges, and to challenge mindset about any key things that were being discussed.

Counsel Inquiry: Thank you.

A different topic, now. I’d like to ask you about HPS’s status as a Category 2 responder under the Civil Contingencies Act of 2004.

What is your view of it being assessed as a Category 2 responder? Do you think there is merit in its categorisation being raised to a Category 1 responder, or do you foresee difficulties if that were to happen?

Dr Jim McMenamin: If I may, if I can present two things there.

Counsel Inquiry: Yes, please.

Dr Jim McMenamin: Both a corporate thing and a personal thing.

From a corporate perspective, I can see that it is really important that we have a Category 1 response labelling, because we are at the heart of the assessment of risk, we are important in all of that.

On a personal basis, I can’t understand why our organisation should not be designated as a Category 1 on the basis of the guidance and response function that we have in supporting major incidents and pandemics.

Counsel Inquiry: Becoming a Category 1 responder carries with it additional responsibilities and duties. Do you consider, Dr McMenamin, that Public Health Scotland is able to provide those and is the right organisation dealing with public health to be able to carry out those additional duties and responsibilities?

Dr Jim McMenamin: Absolutely, with one caveat, and that is obviously resource.

Counsel Inquiry: Funding, yes. All right, thank you.

Finally I’d like to take you through a series of scenario testing exercises and to ask your expert opinion on what you think worked well and what might be capable of being improved.

There are some names here that the Inquiry has not yet heard about, because they are Scottish specific. One back in April of 2009, an exercise called Cauld Craw. What was that all about, Dr McMenamin?

Dr Jim McMenamin: So, as you might imagine, it would be something to do with a crow or the likes. Of course that avian influenza and influenza immediately spring to mind, and that’s exactly what it was about.

Counsel Inquiry: All right.

You note in your statement that the plans for this exercise were in fact overtaken by the swine flu pandemic and although it was well planned, the tabletop exercise itself did not take place. Was it rescheduled?

Dr Jim McMenamin: I beg your pardon?

Counsel Inquiry: Was it rescheduled?

Dr Jim McMenamin: Which, sorry?

Counsel Inquiry: Cauld Craw.

Dr Jim McMenamin: Yeah, I think that it was not rescheduled, particularly because we suddenly had a natural event that was presenting not too long afterwards with the swine influenza pandemic. So my understanding, at least of my own recollection, or of others at the time was that we had a natural challenge that immediately followed.

Counsel Inquiry: Yes. Do you know whether any of the preparations for the exercise were able to be drawn upon when swine flu hit?

Dr Jim McMenamin: Certainly much of the constant evolution of thinking that we had in any of our preparedness was to address many aspects of what were to be covered by that kind of exercise. In particular, for the avian influenza database that ultimately became what you will I’m sure hear more about this the response to Module 2 with the first few 100s approach that we had for gathering clear, concise information about the first cases of any new infection.

Counsel Inquiry: Also known as FF100, isn’t it?

Dr Jim McMenamin: Yes.

Counsel Inquiry: The next exercise on my list is Castle Rock in September of 2010. I’m not going to ask you about the details of that because it simulated a chemical, biological, radiological and nuclear incident, so far from the topic of this Inquiry.

Dr Jim McMenamin: Yes.

Counsel Inquiry: But I would like to ask you about the fact that this was an exercise led by both the UK and Scottish governments.

Do you have a view as to how well a joint operation such as that – and we’re going to come in a moment to talk about Exercise Cygnus – but how something created by governments in two separate nations are capable of providing benefit to both of those nations? Is that something that you would promote, or do you think that the Scottish-only exercises, designed and focused as they were on Scotland, are better in the long run?

Dr Jim McMenamin: I think the truth of it is that you need to have both. We need to have that local exercise capability to see what we can focus on. What sometimes is forgotten is every exercise can only focus on a few key things, it can’t necessarily encompass everything. So having that opportunity to focus on that local issue becomes really important, particularly for the local authorities who might be dealing with that.

Whereas on a UK basis, having an understanding about how to relate to each of those constituent parts of the UK, where we will get key information from becomes important.

And one important thing that I should say about that is that for some aspects of environmental public health, Scotland is entirely reliant through a service-level agreement with the Health Protection Agency, Public Health England and the UK Health Security Agency, and that’s reserved issues like radio, nuclear issues, et cetera.

Counsel Inquiry: Thank you.

Silver Swan took place over the latter part of 2015 and its aim was to assess the preparedness and response of Scotland’s local and national arrangements for an influenza pandemic over a prolonged period.

This, I’m going to describe it as a rather successful exercise, focused on four areas: health and social care, excess deaths, business continuity and overall strategic co-ordination nationally. But of importance you say in your witness statement was what came out of that exercise concerning PPE.

Tell us about that, please, Dr McMenamin.

Dr Jim McMenamin: So inevitably there are key things that come out of every exercise. You hope that you’re challenging perceptions, identifying issues, in the expectation that you’ll be able to address them in subsequent work.

Part of our organisation at the time within Health Protection Scotland was our Antimicrobial Resistance and Healthcare Associated Infection team, that’s shorthanded to ARHAI. It’s with much personal regret and corporately regret that we saw this part of our organisation didn’t come with us into Public Health Scotland, it remained within National Services Scotland. It was, however, the most painless divorce, I’m sure, of medical and nursing teams –

Counsel Inquiry: That’s good to hear.

Dr Jim McMenamin: – because we continued, and continue to this day, to work very closely with our ARHAI colleagues who were an essential part of the pandemic response.

The reason why I’m focusing on that as background first is that it’s this ARHAI team who have become pivotal to us in addressing everything to do with personal protection equipment, and although I can offer my own understanding of that from representing Public Health Scotland and HPS at the time, it might well be that a separate issue that you may wish to consider asking our ARHAI colleagues who remain within National Services Scotland.

The question that you asked, though, was: what happened? The key thing that we can see is that there are issues of interpreting what the safe use of personal protection equipment should be within the NHS. That becomes really important for us to make sure that we can have all of that sharing with the infection prevention and control teams in any of our hospital or secondary care settings, but also across the NHS estate.

That key learning was something that continues to be part of our discussions on an ongoing basis, including what we do for high-consequence infectious disease, and that our ARHAI colleagues are right up the middle of all of that.

Counsel Inquiry: The fact that the provision of PPE and the stockpiling of it and the use of it across the whole of the health system in Scotland had been raised in the latter part of 2015 must have meant that, by the time Exercise Cygnus took part in October of 2016, that knowledge and those concerns could be carried forwards. Because you I think personally attended Exercise Cygnus, did you not, on behalf of HPS? And we know that the aim of that exercise was to assess preparedness and response across the whole of the United Kingdom for pandemic influenza. Did you in fact take to Exercise Cygnus the information and the knowledge that you had gained through Silver Swan?

Dr Jim McMenamin: Yes, indeed, not just me but many of my colleagues who were joining on behalf of either Health Protection Scotland or other parts of the NHS in Scotland.

Counsel Inquiry: And how did you find Exercise Cygnus? It was a huge undertaking, wasn’t it? This Inquiry has heard that it involved 950 participants. As a matter of interest, did you travel down to England in order to attend, or were you attending remotely from Scotland? How did it work?

Dr Jim McMenamin: My memory of that was attending remotely, I think, for that particular one.

Counsel Inquiry: Right. We know it took place over the course of two days and that the initial scenario was that the influenza pandemic had just hit and then the further day was some time beyond that, once systems had been up and running for some time.

When you came away from Exercise Cygnus, did you believe that public health in Scotland was well prepared for the outbreak of a pandemic influenza, or did you appreciate that there were significant lessons that had been learned and preparations that needed to be put into place in order to get that level of preparation to an acceptable degree?

Dr Jim McMenamin: I think the latter. Despite any great work by any number of very industrious colleagues working in the background, my own team included, but yes, there continued to be very significant things that we needed to continue to work on.

Counsel Inquiry: What actions did Public Health Scotland take away from Cygnus and are you able to tell us whether or not, by using a couple of examples, those were carried through and indeed were in place by the time the pandemic hit?

Dr Jim McMenamin: Earlier I spoke about the Scottish Health Protection Network being used as an important vehicle to make sure that we and all of our colleagues then were sharing our own experience and learning. I think that the key thing that we were then coming back to was for personal protection equipment, as you’ve already highlighted, it is an essential bit of what we needed to do, and our ARHAI colleagues in particular were very, very focused on this, but also some other thinking then about high-consequence infectious disease and what we should be doing about that.

You may or may not know that Scotland does not have a high-consequence infectious disease unit. We rely then on, and through service level agreements, the excellent service that’s offered through colleagues in England, where we then have to transfer patients that might require that high-consequence infectious disease management.

That’s part of our reignited discussion that we’re having north of the border currently about what should be the case in the new world that we are living in, where we are learning as much as we can about pandemic preparedness for the future.

Counsel Inquiry: And do you believe, either personally or corporately, that Scotland should have its own HCID system?

Dr Jim McMenamin: I think certainly at the moment corporately that we wish to see what the balance is. We understand that of course there should be value for money in everything that we do. Is there a good enough case in this instance that there should be? My own personal perspective is that I’ll be influenced by our infectious disease clinicians – you spoke to just one of those earlier in the day with Professor Sir Chris Whitty – south of the border, but it will be important that we have a view expressed by all of those colleagues about whether it would be important to have that capability locally or whether we continue to rely on the good grace of our UK colleagues to support us.

Ms Blackwell: Thank you, Dr McMenamin.

Would you excuse my back, please, my Lady?


Ms Blackwell: Thank you. My Lady, I can confirm there were no Rule 10 requests in relation to this witness, and so that completes Dr McMenamin’s evidence.

Lady Hallett: Just one question from me, Dr.

You mentioned in your witness statement that you were doing a lessons learned report, and it would be available by April 2023; was it available by April 2023?

Dr Jim McMenamin: My Lady, my apologies, my understanding is that it was near completion but it’s not yet completed. I can certainly ask my colleagues in the background and try and make that available as soon as possible.

Lady Hallett: That would really helpful, thank you very much indeed.

Well, thank you. I’m sorry we’ve kept you so long, I hope it hasn’t mucked up your arrangements for returning home.

The Witness: Not at all.

(The witness withdrew)

Lady Hallett: Very well, we’ll finish there today, and I am sitting again at 10.30 on Monday.

Ms Blackwell: Thank you, my Lady.

Lady Hallett: Thank you all very much indeed.

(4.30 pm)

(The hearing adjourned until 10.30 am on Monday, 26 June 2023)