Transcript of Module 1 Public Hearing on 28 June 2023
(10.00 am)
Lady Hallett: Yes, Ms Blackwell.
Ms Blackwell: Good morning, my Lady. May I call Gillian Russell, please.
Ms Gillian Russell
MS GILLIAN RUSSELL (affirmed).
Questions From Counsel to the Inquiry
Ms Blackwell: Thank you. Is it Ms or Mrs Russell?
Ms Gillian Russell: Ms.
Counsel Inquiry: Ms Russell, I’m going to ask you some questions based loosely around your witness statement, which we can see at INQ000185343. Could you confirm, please, that this is your witness statement?
Ms Gillian Russell: Yes, correct.
Counsel Inquiry: If we go to page 13, please, we can see that it is signed on 5 May of this year.
Thank you, we can take that down, please.
I say loosely because, as well as the information that you have given, we’re going to draw upon some of the material provided to us by other Scottish witnesses, in particular Ken Thomson, who is the Director General for Strategy and External Affairs in Scottish Government. Can I confirm that you’ve read his witness statement?
Ms Gillian Russell: I have.
Counsel Inquiry: Thank you very much.
During the course of my questioning, please keep your voice up, speak into the microphones, speak slowly, please, so that the stenographer can hear you for the transcript. If you need a break at any time, please just let us know, but we will break part-way through your evidence this morning.
Dealing with your work experience so far as it is relevant to this Inquiry, you have worked in Scottish Government from 1992, for many years as a government lawyer –
Ms Gillian Russell: Yeah.
Counsel Inquiry: – before moving on, as a senior civil servant, to a range of policy roles. You were Director of Safer Communities from June of 2015 on an interim basis, and then from December of 2015 on a permanent basis, holding that role until March of 2020.
Then you were Director of Health Workforce with responsibility at national level for the health workforce and aspects of the social care workforce, which is a position you have held since March of 2020; is that right?
Ms Gillian Russell: That’s correct.
Counsel Inquiry: Thank you very much.
Ms Russell, because you are the first Scottish witness to deal with matters of – dealing with the Scottish Parliament and the Scottish Executive, I’m going to use you, if I may, to introduce this part of the Inquiry’s evidence.
Devolution in Scotland has its basis in the Scotland Act of 1998, as amended, most extensively by the Scotland Acts of 2012 and 2016.
Prior to the establishment of the Scottish Parliament in 1999 under the Act, the Scottish Office oversaw most public services in Scotland as part of the United Kingdom Government, with policy responsibilities such as health and local government; is that right?
Ms Gillian Russell: Correct.
Counsel Inquiry: The 1998 Act followed a referendum on devolution in 1997, and it established the Scottish Parliament and the Scottish Executive, which has since been renamed the Scottish Government.
Ms Gillian Russell: That’s correct.
Counsel Inquiry: Scottish devolution is based on a retained powers model of devolution in which broadly the power to make legislation about matters not reserved in the 1998 Act is devolved to the Scottish Parliament.
Ms Gillian Russell: Correct.
Counsel Inquiry: As a result, the Scottish Parliament has the powers to make primary legislation, Acts of the Scottish Parliament, on a range of matters commonly called devolved matters?
Ms Gillian Russell: Correct.
Counsel Inquiry: Thank you.
Could we put up, please, INQ000184894. This is a table which illustrates the difference between devolved matters and reserved matters, and it comes from Ken Thomson’s witness statement.
So on the left-hand side we have a list of matters devolved to the Scottish Parliament: agriculture, forestry and fisheries; education and training, environment; Health, care and social services – important for this Inquiry; housing and land use planning; law and order; local government; sports, arts and tourism; parts of social security; some forms of taxation; and many aspects of transport.
On the right-hand side, we have the reserved matters, which we can see there, including defence and national security, again important for this Inquiry.
Thank you very much, we can take that down, please.
There are also, of course, many areas where the devolved responsibilities of the Scottish Government and Parliament interact with those of other governments in many reserved areas, where the United Kingdom Government policies or Westminster legislation have impacts on devolved matters, so it’s not simply a split as we see in that table.
Ms Gillian Russell: Yeah.
Counsel Inquiry: There are matters which each government and parliament deal with which interact together?
Ms Gillian Russell: Correct.
Counsel Inquiry: The Scottish Government is comprised of a First Minister and a Deputy First Minister, Cabinet secretaries, law officers and also ministers, and set out in part 2 of the 1998 Act, the First Minister is nominated by the Parliament and appointed by the Sovereign, and other Scottish Ministers, except law ministers, are appointed by the First Minister –
Ms Gillian Russell: Correct.
Counsel Inquiry: – is that right?
The Lord Advocate and Solicitor General are appointed by the Sovereign on the recommendation of the First Minister?
Ms Gillian Russell: Correct.
Counsel Inquiry: Cabinet government in the Scottish Government operates on a similar basis to that at Westminster and Cabinet decision-making operates on the basis of collective responsibility; is that right?
Ms Gillian Russell: Yes, correct.
Counsel Inquiry: Civil servants working for the Scottish Government are part of the unified United Kingdom civil service –
Ms Gillian Russell: Correct.
Counsel Inquiry: – and senior civil service grades are the same as elsewhere?
Ms Gillian Russell: Correct.
Counsel Inquiry: And like Whitehall departments, the Scottish Government has its own distinct terms and conditions of employment?
Ms Gillian Russell: Correct.
Counsel Inquiry: The civil service in the Scottish Government does not have departments on the Whitehall model but, rather, a more flexible and unified structure, comprising directorates and executive agencies –
Ms Gillian Russell: Correct.
Counsel Inquiry: – and a number of director generals. Each oversees groups of directorates and agencies, and there are also a number of non-ministerial office holders, together with their staff?
Ms Gillian Russell: Correct.
Counsel Inquiry: The Scottish Government consolidated accounts for the year ended 31 March 2008 summarised changes made to government arrangements at that time, including a move from a department structure, mirroring minister portfolios, to a directorate structure, as we’ve just seen, intended to enable a more flexible organisational approach.
In your view, did that succeed in its intention?
Ms Gillian Russell: Yeah, and it was also intended to support the – we brought in the National Performance Framework, with a set of outcomes which we were to work to across government, so part of the director-led model which was put in place was intended to support an outcomes-based approach to government.
Counsel Inquiry: Thank you.
Could we have on screen, please, INQ000184895.
We can see at the top under paragraph 21:
“[Scottish Government] Main is comprised of core directorates which sit in director general families, agencies and non-ministerial offices as detailed in the table below.”
So in the left-hand column we have the “Scottish Government Director General families”, as they’re called, and the agencies in the middle, with the non-ministerial offices (NMOs) on the right-hand side.
How do these three sets of organisations work and interact with each other?
Ms Gillian Russell: So on the left I would describe those as the core DGs within Scottish Government.
Counsel Inquiry: Yes.
Ms Gillian Russell: Then the next column out is our agencies, who we work very closely with, obviously, and some of the chief execs of those agencies might sit within the DG families, and then we’re moving out again to our non-ministerial offices.
So overall I would say all of those people would work as colleagues together, but there is a difference in the nature of the set-up for each of those columns.
Counsel Inquiry: Right, thank you.
On the subject of permanent secretary, like the United Kingdom Government, they are the proper accounting officer, but unlike the United Kingdom Government, with one permanent secretary per department, in Scotland there is one permanent secretary to the Scottish Government; is that right?
Ms Gillian Russell: Correct, he is the principal accountable officer and then the directors general would have their accountable officer status for their DG families.
Counsel Inquiry: Thank you.
The Civil Contingencies Act 2004 was – when it was introduced, civil protection was already largely devolved in Scotland, wasn’t it, but the Scottish Parliament consented to part 1 of the Act being extended to Scotland, and that still remains the case today?
Ms Gillian Russell: Yeah, that’s correct.
Counsel Inquiry: In terms of resilience, then, and EPRR, emergency preparedness, resilience and response, in Scotland the Resilience Division is currently located in the directorate Performance, Delivery and Resilience, within the directorate general for Strategy and External Affairs; is that right?
Ms Gillian Russell: It is now. When I was there, it was sitting within Education and Justice –
Counsel Inquiry: Yes.
Ms Gillian Russell: – as part of the directorate for Safer Communities, so that’s changed since I – I’d emitted(?) role in 2020.
Counsel Inquiry: That changed in 2020?
Ms Gillian Russell: I think that did change in 2020, yeah.
Counsel Inquiry: Thank you.
Within Scottish Government the Resilience Division were responsible for all aspects of resilience, and it is led by an SCS deputy director; and was it divided into a number of teams?
Ms Gillian Russell: Yeah, so there was a deputy director at SCS level and then a number of teams sitting under that covering the sort of broad range of resilience functions that we were doing at a national level.
Counsel Inquiry: Firstly, the resilience function provided a central capacity within the Scottish Government to lead preparations for and frequently to deliver executive management of resilience operations; is that right?
Ms Gillian Russell: Correct, yes.
Counsel Inquiry: The central team would work with other parts of Scottish Government, and with partner organisations, such as local authorities and public bodies, to ensure appropriate consideration was undertaken of potential risks?
Ms Gillian Russell: Correct, yeah.
Counsel Inquiry: Examples of those risks are flooding, transport disruption, winter weather, industrial disputes, and, significantly for this Inquiry, the Covid-19 pandemic?
Ms Gillian Russell: Yeah, yeah, all of those, correct.
Counsel Inquiry: Thank you.
Could we put up, please, INQ000102938. This is a document titled Preparing Scotland – Scottish Guidance on Resilience – Philosophy, Principles, Structures and Regulatory Duties.
If we move to page 2, please, we can see that, if we could just have a look at the whole page, first of all, thank you, we can see bottom left-hand corner it’s signed by John Swinney, the “Deputy First Minister” –
Ms Gillian Russell: Correct.
Counsel Inquiry: – “with responsibility for Resilience”.
Ms Gillian Russell: Yeah.
Counsel Inquiry: We’ll move in a moment to talk about his role in resilience. We can see it’s dated June of 2016.
Let’s look at the ministerial foreword, please, to identify what this document is intended to achieve:
“Resilience is everyone’s business. Individuals, communities, emergency services and the wider public sector including Scottish Government, as well as voluntary organisations and businesses all have their part to play in making Scotland safe and secure.”
If we scroll down, please, to the next main paragraph:
“This revised Preparing Scotland guidance sets out the philosophy, principles and practices that act as the building blocks for resilience. It is based on the experience and expertise of the resilience community within Scotland. Resilience professionals will be the main readership of this guidance and, with the support of the Scottish Government, they are key to effective co-ordination of the five key activities of Integrated Emergency Management, namely assessment, prevention, preparation, response and recovery.”
Then this:
“It is vital, however, that we all see Scotland’s resilience as our responsibility to support the safety and well-being of our neighbours and communities across the country, from those in remote and rural locations to those in our towns and cities. This message, that resilience is everyone’s business, needs to be echoed across Scotland and I would urge you all to take this message forward.”
Now, if we move to page 5, please – thank you – we can see that the purpose of the guidance is:
“… not intended to be an operations manual, but is instead guidance to responders assisting them assess, plan, respond and recover. It establishes good practice based on professional expertise, legislation and lessons learned from planning for and dealing with major emergencies at all levels. It reflects a process which prepares for emergencies from the identification of a risk to the completion of the recovery process.”
So as we can see there, it’s a set of guidance intended to cover the whole –
Ms Gillian Russell: Yeah.
Counsel Inquiry: – of the process from identification of risk down to the very end of the recovery process.
Ms Gillian Russell: Yeah, and it was intended to be put in place in a way that was user friendly.
Counsel Inquiry: Yes.
Ms Gillian Russell: So if you go on to the Ready Scotland website, you can see quite easily how that guidance flows out from central right down into community and the guidance around communities, for example.
Counsel Inquiry: We’ll look at that in a moment, yes.
Could we go to page 7 of this document, please. Thank you, and just zoom in to the “‘Hub and Spokes’ Model” of “Preparing Scotland”.
Now, we can see that there are several issues here to be considered. Can you explain to us, please, Ms Russell, how you would use this table, this diagram, in order to demonstrate the preparedness process in terms of risk assessment and response to any emergency?
Ms Gillian Russell: Yeah, so the central document Preparing Scotland sets out the detail around, I suppose, that higher level strategic thinking about how to do your preparation for – in relation to risk.
Then, as you see, what are called the spokes, each have their own guidance sitting underneath it. So, for example, if you press on “Community Resilience”, what you will get is then a whole set of guidance about how to respond in relation to that, building resilient communities, and there’s a whole set of guidance dated May 2019 that sits underneath that button that sets out principles and approaches to how to go about ensuring that you have that resilient community at local level.
So if you go round each of the buttons, they’ll each have a set of, I suppose, cascading guidance which fits within the subject heading.
If you look at “Care for People” as another example, the Care for People guidance which was published in 2017 sets out a whole set of things that you will want to consider if you’re an organisation caring for people, and that would include things from setting up, for example, shelters to thinking about diversity and inclusion within your communities.
So I suppose it was a way to try to help people to navigate what could be quite a complex environment, and really support people in their thinking in terms of their own preparation, bearing in mind that, in terms of the Civil Contingencies Act, the responsibility would still sit on the first and second responders, but really that point, resilience is everybody’s business, how do you get to a point where resilience is really embedded through your society, through this kind of approach.
Counsel Inquiry: So who would be expected to use this guidance and to access the hub and spokes model in the way in which you’ve described?
Ms Gillian Russell: So it is publicly accessible information, so if you were a community group you could go onto this and actually have a look and say, “Right, I’m going to have a look at community resilience. What could I do as a community group to improve the resilience of my community?” So actually it was like a multifaceted audience that could use this. It’s also something that we would expect our responder community to use, and we also had, obviously, in terms of overarching structure – probably we’ll come to this later – our strategic resilience partnership, the regional resilience partnerships, and then our local resilience partnerships.
Counsel Inquiry: If we pressed on Risk and Preparedness Assessment, which is in the top left-hand spoke, what would we see there and how would that assist us? Bearing in mind that we’re told it’s not an operations manual –
Ms Gillian Russell: Yeah, yeah.
Counsel Inquiry: – but it’s guidance.
Ms Gillian Russell: So it would give you principles and ways and suggested ways of doing that risk and preparedness assessment, and I think there is evidence within the papers of how that started to then play out in practice. So it’s, I suppose, a way of trying to support people culturally to think about resilience and then giving them some very practical ways of analysing and understanding what the risks are and how to mitigate them for them and their local areas.
Counsel Inquiry: How does this sit with the Ready Scotland website with its hyperlinks?
Ms Gillian Russell: Yeah, so that sits within Ready Scotland, so you can go into Ready Scotland and find that material.
Counsel Inquiry: And find this?
Ms Gillian Russell: Yeah.
Counsel Inquiry: Let’s have a look at that, please.
It’s at INQ000196610. If we scroll down, please, I think the next sheet should be a series of hyperlinks. Yes.
Ms Gillian Russell: Yeah, yeah.
Counsel Inquiry: So this is what we would see if we went on the Ready Scotland website, and explain to us, please, Ms Russell, what this is and how this would help.
Ms Gillian Russell: Yeah, so, I mean, they are really the spokes that we were talking about, so you would just go into any of those topics and that would give you a whole set of guidance. Some of the guidance is pretty long, some of it is much shorter and more concise, depending on the subject area and the level of detail it was felt necessary to provide.
But overall, if you look across all of the topics, the totality of the topics should be supporting your overall strategic priority about creating that resilient country that was talked about by Mr Swinney in that foreword.
Counsel Inquiry: Of course this is a public-facing website.
Ms Gillian Russell: Yes.
Counsel Inquiry: Anybody can go on this.
Ms Gillian Russell: Yes.
Counsel Inquiry: But would you also expect those within the Resilience department to need to access these sorts of documents or not?
Ms Gillian Russell: Yeah, so part of the role of Resilience Division was to make sure that this material was user friendly and publicly available in a format that was accessible to people. So that was some of the work. And I suppose it’s always – you know, Resilience was always on an improvement cycle, so, you know, we’d always be seeking to learn what was working, what needed to change and improve. So the documents, as they are now, would improve over time as we took feedback and heard how they were working in practice for people.
Counsel Inquiry: How often would that take place? Was there a set time at which the documents would automatically be reviewed and amended, or was it a reactive process and only took place if an issue arose and it was brought to your attention that one of the documents perhaps needed looking at?
Ms Gillian Russell: So I think the time I was in role was really the point at which all of this material was being assembled and put out into that public-facing forum. Since I’ve left, in 2020, I’m not sure how that process has worked, but certainly the expectation was that that would be adjusted over time.
Counsel Inquiry: Right. But these documents don’t have a strict date by which they have to be reviewed?
Ms Gillian Russell: No, they didn’t, no.
Counsel Inquiry: Thank you, we can take that down now.
Lady Hallett: One of the key activities of emergency management was said to be prevention. What would I click on if I wanted to look at prevention?
Ms Gillian Russell: So I think if you looked at, for example, building resilient communities, there would be – there would be material in the Building Resilient Communities guidance that would tell you about things to be aware of, things to think about, things that you might want to plan as a community to enable you to think preventatively. I mean, some of it is – for example, the A9 corridor, in winter we always have a lot of issues along the A9 corridor, so a lot of work was done with communities along that corridor so they would be better able to respond as communities to bad weather over periods of time, and that was quite an effective approach.
So I suppose prevention in the sense of better adapting your response to things that happen on a regular basis would be an example.
Lady Hallett: Better preparing your response is not preventing, is it?
Ms Gillian Russell: Well, I suppose if you’re talking about broader prevention, you might go back to the sort of policy areas, so if I looked at the strategic risk assessment, and the way that the strategic risk assessment was prepared, for example, the flooding element of that was done along with our flooding policy colleagues, so actually getting them to think about the flooding risk might help them to design their future policies differently.
So that would – so you’re not necessarily going to find that in this, but in terms of how the strategic risk assessment was done for Scotland, you would be working with different policy areas to help them understand risk, and perhaps think differently about how to design their policies for the future to mitigate that risk.
So I think that is probably getting more into a preventative space.
Ms Blackwell: If we look at the bottom right-hand corner, we can see “Regional Resilience Partnerships’ Risk Preparedness Assessment Guidance”. Now, it’s right, isn’t it, that there was a system of strategic co-ordinating groups, or SCGs, which then transferred into a series of regional resilience partnerships, or RRPs, together with local resilience partnerships, which are LRPs.
The SCGs existed in resilience planning in Scotland prior to introduction of the RRPs. What was the shift between the two, and how did it manifest itself practically?
Ms Gillian Russell: So I took up post in 2015 so the regional resilience partnerships were already in place by then, so I worked with them as entities from 2015 –
Counsel Inquiry: There were eight SCGs, weren’t there, which then became three regional resilience partnerships?
Ms Gillian Russell: Yeah. So the three regional resilience partnerships, north, east and west, were all headed up by assistant chief constables, and so I think they mirrored the – because we had the reform of police and fire service and the creation of the single police and fire service in Scotland from April 2013, so I think the regional resilience partnerships – to some extent the police and fire service both have north, east and west areas sitting above their divisional command structures. So I think that the regional resilience partnerships were able to build on the changes that came forward from the single police and fire service, and allowed that more strategic look-across. So the north region, looking at what the risks were for the north region, how would that north region then respond and plan in relation to that. So you can see that coming through the documentation.
There was then reviews of the regional resilience partnerships, risk assessment and where we saw the mitigation, and that then, again, was a continuous improvement cycle: where were the gaps, what was needed to improve.
Counsel Inquiry: So each of the regional resilience partnerships performed their own regional risk assessments, and did that draw upon the Scottish risk assessment?
Ms Gillian Russell: It did, yeah.
Counsel Inquiry: Did that cascade down into the local resilience partnerships that sat within each of those regions?
Ms Gillian Russell: Yes, correct, so it was meant to be a kind of integrated national/regional/local system.
Counsel Inquiry: Right, thank you.
Lady Hallett: Can we just slow things down a little?
Ms Blackwell: Yes, certainly. My fault, sorry.
We can take that down, please, thank you.
There are three key differences between the English and Scottish local resilience structures. First, in terms of the regional tier that we’ve just been discussing, Scotland has a statutory requirement for a regional tier of RRPs, doesn’t it, whereas England doesn’t have a formal legal requirement for the regional tier.
What do you think are the benefits of having that regional tier?
Ms Gillian Russell: So I think it did enable us to create capacity at that regional level, so there was quite a lot of support put into the capability and skills to support those regional partnerships. It also meant that we could assess across that, and you’ll see that it was the chief fire officer in the fire service that did that assessment, across each resilience partnership, to look at what they were preparing, what the risk assessments and mitigations looked like. So I think it supported a slightly different approach.
As I’ve said already, given we had the single police and fire service and a different understanding of how we could understand Scotland in terms of east, north and west, I think it fitted with that model as well. So I think that was helpful, because obviously the police and fire service are Category 1 responders, and the ambulance service as well is a national service in Scotland, so it supported some of the national service providers to be working in that way in a regional level.
Counsel Inquiry: The second difference is the local tier. England has a statutory requirement for a local tier of local resilience forums. Scotland doesn’t have any formal legal provision for that, but, as we’ve just discussed, there is in fact a level of local resilience partnerships?
Ms Gillian Russell: Correct, yeah.
Counsel Inquiry: Do you think that there’s any disadvantage to not having that as a legal requirement? Has that made any difference to the way that things are arranged in Scotland?
Ms Gillian Russell: It’s not something that’s been raised with me as a concern. I mean, one of the – one of the principles is subsidiarity, so you would deal with things at the level at which it was most appropriate to deal with them. So very localised things obviously you would be dealing with them only within a single LRP, and then obviously, depending on the nature of what you were doing, you might need more engagement with your regional resilience partnership or, indeed, that whole of government national response as appropriate.
Counsel Inquiry: All right.
Thirdly, there is a difference in the separation or combination of preparedness and response, so in England the local resilience forums cover preparedness only and strategic co-ordinating groups cover response and recovery, but in contrast the regional resilience partnerships and local resilience partnerships in Scotland perform the dual function of preparedness, response and recovery, don’t they?
Ms Gillian Russell: Well, they’re all part of the same cycle, really, I think, so we would view those as part of an overall integrated cycle looking at resilience.
Counsel Inquiry: Do you view that as an advantage or a disadvantage, having all of that dealt with by the same organisations?
Ms Gillian Russell: I would – I would view it as an advantage, because it does mean that you can … I think my Lady made the point earlier about where’s the prevention. I think if you have responsibility for the whole, you’re much more likely to get into that preventative space and think differently about what you need to do in terms of your substantive policy and planning to deliver resilience for communities.
Counsel Inquiry: We’re now going to look at some other groups, organisations, SGoRR, SGoR(O) and SGoR(M).
Can we have on screen, please, INQ000102938, at page 25, thank you very much.
These are the response and recovery organisations:
“SGoR(M) [which is the ministerial group] sets the strategic direction for Scotland’s response. It acts on behalf of, and reports to, the Scottish Cabinet. In the response phase, membership of SGoR(M) is determined by the nature of emergency.
“The procedures that support [it] will be activated flexibly. A judgement will be made by the Scottish Government in each set of circumstances about precisely what elements need to be activated. An essential element of a national response will be the activation of the Scottish Government Resilience Room. Resilience Partnerships will be advised of the activation of SGoRR as soon as is practicable.”
If we look further down to the next body, the Scottish Government Resilience (Officials), SGoR(O), it’s:
“… a group of senior Scottish Government officials drawn from all relevant Directorates (ie government policy areas such as Business and Industry, Health, Environment etc), plus external members on occasion. It will:
“- analyse information received by the SG [Scottish Government] and provide advice to the SGoR(M) on options for handling the consequences of the emergency
“- oversee implementation of decisions taken by the SGoR(M)
“- ensure co-ordination of Scottish Government activity.”
Finally, the “Scottish Government Resilience Room” itself:
“When the scale or complexity of an emergency is such that some degree of central government co-ordination or support becomes necessary, Scottish Government will activate its emergency response arrangements through SGoRR. The precise role of SGoRR will vary depending on the nature of the emergency.”
We can see there a series of bullet points which set out what the Resilience Room is designed to do.
So, just pausing there, Ms Russell, can you explain to us when the setting up of the SGoRR, Resilience Room, would be necessary and how it would interact with the ministers group and the operations group?
Ms Gillian Russell: Okay, so perhaps take an example, if that would be helpful?
Counsel Inquiry: Yes, please.
Ms Gillian Russell: So a couple of years ago, pre-pandemic, there was very significant flooding in Scotland, across Scotland, and it became apparent that it wasn’t going to be managed within a local resilience partnership or within a region, so SGoRR would have been activated.
On that SGoRR activation, you’d be looking to see, like, what are your strategic priorities now for managing this flooding event, who do you need round the table to do that well, and then what would be the ministerial engagement in that.
So if I was gold command for that, we would probably have a SGoRR officials meeting which would involve our resilience – our regional resilience partnerships, relevant first responders, relevant policy officials in government and agree what the approach should be to manage through that emergency.
Counsel Inquiry: May I just ask, is the decision to activate made by the Resilience Division or at senior ministerial level?
Ms Gillian Russell: We would generally give advice about the need for activation depending on the subject matter. I mean, in my time in the role, there was a number of terrorism incidents, there were sort of specific weather-related incidents, we had things like the Trump visit where SGoRR was activated over that period because of the level of safety and security issues. So the activation would depend on the nature of the event.
Some events were known, so it would be a planned activation, others would emerge and it would be, you know, very quick advice to ministers to say: We think we need to activate SGoRR and put in place the arrangements that are going to enable us to strategically co-ordinate through the emergency that we were dealing with.
Counsel Inquiry: How does the activation of the Resilience Room work with the other two groups, the SGoR(M) and SGoR(O)?
Ms Gillian Russell: Yeah, so they’re all really part of the same thing. So the SGoR Officials would be without ministers, and we generally have SGoR Officials to try and flush out what are the issues, what need to be addressed, then we’d have a SGoR Ministerial if necessary. Generally the DFM or the FM might chair, depending on the nature of the incident, and you would have relevant ministers round the table. So, in a flooding, you would have the minister responsible for the fire service, whoever was responsible for environment, transport, et cetera, sitting round that table. So it’s really all part of the same arrangement.
So when you activate SGoRR, depending on the nature you would be put in placing your Officials meetings and your Ministerial meetings, and then you would have kind of a battle rhythm over the number of days or weeks it took to work your way through that particular incident.
Counsel Inquiry: How would the activation of SGoRR work with and interact with the United Kingdom Government in a nationwide crisis?
Ms Gillian Russell: Yeah, so there would be examples of that, so if COBR stood up – so, for example, if there is a fuel disruption issue, that might be an example of that. And I worked very closely with resilience colleagues in Cabinet Office, Katharine Hammond was my main point of contact there, and we also would work with the Welsh Government, so issues that were across Wales, England and Scotland, I would work closely and had a good relationship with Welsh Government as well, as senior officials, and then that would be mirrored with my kind of officials within the Resilience Division, we’d have cross-government contacts and relationships.
Counsel Inquiry: We will hear during the course of this Inquiry from the Deputy First Minister, John Swinney, who has provided a witness statement to the Inquiry in which he gives his view that “SGoRR had developed significantly” from the first moment that it was developed, and it is “a reliable and dependable grouping with expertise in handling resilience incidents”. Do you agree with that description?
Ms Gillian Russell: Yeah, we did a lot of work to create the right skills and capabilities in that team to do that work well, and we had very good relationships with our Category 1 responders and there was a lot of work done, both at senior and tactical operational level, to make sure that those relationships worked well and we were well placed as an overarching team where needs be to work with together across Scotland.
Counsel Inquiry: As you know, in the UK Cabinet Office, the Civil Contingencies Secretariat is split between the COBR unit and the Resilience Directorate. Do you think that that is something which SGoRR would benefit from or not?
Ms Gillian Russell: I think because we only have a single government, it makes sense to keep those functions together. But I think it’s just important to note that the functions of Preparing Scotland, that we’ve been talking about earlier, and the function of being able to do that resilience response through those arrangements are different things. So the government – the overall capacity needs to be sufficient to do both well. If that makes sense?
Counsel Inquiry: Yes, thank you.
John Swinney held ministerial responsibilities for resilience as Deputy First Minister from November of 2014 to March of 2023, and it’s now held by the Cabinet Secretary for Justice and Home Affairs, I think. He held the resilience portfolio concurrently with other wide-ranging portfolios, Cabinet Secretary for Finance and Sustainable Growth in the Scottish Government, and Cabinet Secretary for Education and Skills.
Did you see that as a problem? Do you think that his portfolio was too wide-ranging? Do you think that he should have been able to concentrate more on resilience? Or do you think that it was a benefit for him to have his eyes across lots of areas of Scottish Government?
Ms Gillian Russell: So obviously you’ll hear from Mr Swinney tomorrow, I think. My view was he was very clear about the importance of resilience and always gave it the attention that it needed, and was very, very meticulous about that throughout the whole time that I worked with him.
Yes, you know, if it was appropriate, it would be delegated to others, but where he saw the need he would always step in. And there were particularly challenging sets of issues that he very personally took the lead in. Actually, as Deputy First Minister, it was helpful as well because he obviously had a cross-cutting role as Deputy First Minister in his broader role. But I didn’t ever see that as a problem.
Counsel Inquiry: What is the Cabinet subcommittee on – Scottish Government Resilience CSC (SGoR); is that how I say it correctly?
Ms Gillian Russell: So the subcommittee on – have you got a reference to that?
Counsel Inquiry: Cabinet subcommittee on Scottish Government Resilience. I understand that it’s the Scottish equivalent to the United Kingdom Government’s NSC(THRC), so the threats committee –
Ms Gillian Russell: Ah, right, okay. Yeah, so that would be ministers coming together to look collectively at some of the risks.
Counsel Inquiry: Is that a group which sits all of the time or is that something which is stood up at an appropriate moment?
Ms Gillian Russell: So that may be something that has become clearer in the last three years since I’ve been doing the role. So it may be something – is it in Ken’s statement?
Counsel Inquiry: In fact I think there is a reference to it in Preparing Scotland, so if we can go back to that document.
Ms Gillian Russell: Yes, let’s go back to that.
Counsel Inquiry: It’s INQ000102938 and page 25. Thank you.
In fact, if we can highlight, please, the group itself, which is under the heading “Preparation”. Thank you.
“In preparation, the role of CSC SGoR is to give ministerial oversight to strategic policy and guidance in the context of resilience in Scotland. [It] meets in preparation for emergency response and keeps abreast of matters related to promoting and improving civil protection, contingency planning and preparing for specific contingencies such as pandemic influenza.
“Whilst acknowledging the independence of Category 1 responder agencies to undertake preparation pertaining to resilience, such preparation will generally take place within an overarching structure of legislation and national guidance. It is the role of CSC SGoR to approve new national guidance and to make decisions on the taking forward of new legislation.”
Sorry, go on?
Ms Gillian Russell: No, the reason I’m pausing is, in my experience in the role, I would say probably Cabinet overall took decisions in relation to matters in relation to resilience rather than working through that Cabinet subcommittee. I mean, obviously I’d be happy if there’s further specific examples of what the Cabinet subcommittee did, but in my recollection it was probably more Cabinet as a whole that would have looked at resilience issues rather than that subcommittee.
Counsel Inquiry: All right. Do you happen to know how often the group met?
Ms Gillian Russell: I don’t, and –
Counsel Inquiry: We will ask other witnesses.
Ms Gillian Russell: Yeah, I think perhaps to ask other witnesses, but my recollection would be that issues were more dealt with through the overarching Cabinet rather than through a subcommittee.
Counsel Inquiry: One thing I think that you do have experience of is the directors network?
Ms Gillian Russell: Yes.
Counsel Inquiry: How often did that meet and who would be invited to those meetings?
Ms Gillian Russell: Yes, so the directors network meets every week on a Thursday morning and all of our directors from across government go to that meeting every week and it’s used as an opportunity to look at strategic issues, update on key things that all directors need to know, it’s attended by the Executive team as well, and it’s the – I suppose, the main way, verbally, of keeping directors updated and it’s a way of sharing information as well across that directors network.
Counsel Inquiry: Was there any wider briefing of Cabinet, other than the directors’ meeting?
Ms Gillian Russell: So the directors’ meeting was – directors are the officials, so in terms of briefing Cabinet, I mean, Cabinet would be kept updated on resilience issues generally, there would be ongoing discussions with Cabinet, I mean, certainly, you know, in terms of response events, Cabinet would be very engaged. We would have gone to Cabinet for decision-making around kind of the overarching strategic approach to resilience we were taking forward through the Scottish risk assessment and the various other material that you’ve referred to.
Counsel Inquiry: So there was no difficulty getting access to whoever you needed to speak to in order to discuss matters of preparation or resilience or anything like that?
Ms Gillian Russell: No, there wasn’t, I would say the government generally put a big priority on making sure that we were always on top of these issues and that they were engaged early and effectively on things.
Counsel Inquiry: What is the Scottish Resilience Partnership?
Ms Gillian Russell: So – the Strategic Resilience Partnership, I think it is, yes.
Counsel Inquiry: Strategic Resilience Partnership, sorry.
Ms Gillian Russell: So I set that up in 2016, bringing together the Cat 1 responders at more senior level and the regional resilience partnership leads, so it was a mix of local authority, chief execs, senior police and fire, senior ambulance, coastguard, SEPA were there, and the point of that Strategic Resilience Partnership was to provide that sort of guiding coalition across resilience as we were supplementing it in Scotland.
Counsel Inquiry: Did you perceive that there was a gap that needed to be filled when you first implemented the Strategic Resilience Partnership?
Ms Gillian Russell: So what I felt was needed was an open space for frank discussion about key issues in relation to resilience that was future facing, so the agenda was really set on the basis that – of looking ahead and looking at issues that perhaps needed more attention or just a bit of a step back: Are we doing everything that we need to be doing? And those leaders round that table were viewed as the people that could help challenge and discuss that frankly.
Counsel Inquiry: Was it always the same people, the same individuals, who would attend the partnership, or was there a varying membership from time to time?
Ms Gillian Russell: It was the same membership, but we’d obviously bring in different people depending on the topic that was to be discussed, and quite often the Deputy First Minister would come and chair part or all of those meetings.
Counsel Inquiry: When you refer to it as a safe space for open discussion –
Ms Gillian Russell: Yeah.
Counsel Inquiry: – how did you ensure that that was the atmosphere that was generated?
Ms Gillian Russell: I think that was the expectation of setting up the sessions, that people would feel free to speak and be open and challenge, and that was the point of bringing people together, and also just be honest about things, areas that they felt were of risk or areas that we needed to do more work on collectively at that senior strategic level.
Counsel Inquiry: Did you have experts invited in to provide advice on certain issues?
Ms Gillian Russell: Yes, we would do from time to time depending on the issue. I remember, for example, a session on cyber risk and resilience, and we would have had people come to that meeting with an expertise in that area. Just as an example.
Counsel Inquiry: Do you think it succeeded in its intention to provide open discussion on issues?
Ms Gillian Russell: So I think it did. I think obviously there’s always more work to do on these things, so how do you improve that. I also think it created very strong relationships across that strategic community, and I think that that grouping of senior leaders moved into the pandemic and were able to provide a lot of leadership as a leadership grouping through the pandemic. I mean, I had moved to a different role by then, but I do understand that they were – worked very well together through the pandemic.
Counsel Inquiry: One of the purposes of the group was to provide advice to the resilience community on how best to ensure that Scotland is prepared to respond effectively to major emergencies.
Ms Gillian Russell: Yeah.
Counsel Inquiry: How did you take that forwards? As a practical matter –
Ms Gillian Russell: Yeah.
Counsel Inquiry: – who was invited to be involved in the discussion of the effective preparation of Scotland for major emergencies?
Ms Gillian Russell: So it would – it was probably topic-specific, so we would be looking at topics across years, and then obviously taking actions from those meetings and implementing the actions that came out of those meetings.
Counsel Inquiry: Thank you.
I want to now move to discuss the National Risk Assessment and the National Security Risk Assessment and the Scottish Risk Assessment.
Ms Gillian Russell: Yeah.
Counsel Inquiry: First of all I want to ask you about the level of involvement of Scotland in the National Risk Assessment process.
Could we have on screen, please, INQ000147769.
This is the 2016 National Risk Assessment – thank you – as we can see from the front sheet. If we go to page 2 and the foreword, please, thank you.
“The United Kingdom has an enviable reputation for stability and resilience, a reputation built on the foundations of robust risk management and tried and tested emergency response and recovery arrangements. This resilience is crucial to supporting our people and businesses and through them the economy and society.”
If we could move down the page, please, and highlight the paragraph at the bottom there beginning with the word “Compiling”. Thank you.
“Compiling the National Risk Assessment requires significant support from Government Departments, Devolved Administrations, Chief Scientific Advisers, local resilience practitioners and external partners, including universities and industry. It is only with your help that we are able to produce robust and credible assessments and translate them into collective action that prepares us for the challenges we face.”
What level of detail did Scotland, as one of the devolved administrations, have in the preparation and production of the National Risk Assessment?
Ms Gillian Russell: So we would sit in some of the infrastructure that was driving the National Risk Assessment process, and would attend various UK groups and would feed in that way. I probably can’t be any more precise than that. I couldn’t give you an example of: here’s what Scotland thought, here’s how it fed into the National Risk Assessment and show a clear line around that. I think that’s something that perhaps if you want more detail on that, we could come back to that and take that as something to come back to.
Counsel Inquiry: Well, did the involvement include the provision of information, the attendance of meetings? How practically did Scotland become involved and contribute to the National Risk Assessment?
Ms Gillian Russell: So I … so from my recollection there was quite a big infrastructure at UK level and we would sit and attend various meetings. So, for example, on CBNR or related – groups relating to, for example – you know, concerned about a black start, power outage, so there were different bits of UK infrastructure that would look at all of these things and we would be often represented on them as officials.
I suspect that that was the main way in which we were involved. I can’t say whether the National Risk Assessment was given to us in draft and we were asked to comment on it. I can’t say that we would have done that. Certainly what we did do was take that National Risk Assessment and then look at what a Scottish risk assessment should look like on the back of that.
Counsel Inquiry: Well, we’re going to move to that in a moment.
Ms Gillian Russell: Yeah, yeah.
Counsel Inquiry: But did you have any concerns that Scotland was not being adequately involved in the production of this document, during your time in office?
Ms Gillian Russell: Not that I’m aware of. Not concerns that we weren’t adequately involved.
Counsel Inquiry: All right. Well, let’s take that down, please, and look at the 2019 NSRA, which is at INQ000147771.
I just want to look at a couple of paragraphs within this document.
Let’s go to page 3, please. Thank you.
We can see this is the 2019 National Security Risk Assessment. If we go to page 3 and look at the penultimate paragraph of the foreword, it says that:
“The production of the NSRA has been supported throughout by an extensive stakeholder group, who have been dedicated in providing evidence and challenge. This has included relevant government departments, Devolved Administrations, Chief Scientific Advisers, the intelligence community, and Local Resilience Forums, as well as experts from academia and industry.”
So a similar type of statement to the 2016 NRA.
Ms Gillian Russell: Yeah.
Counsel Inquiry: The same questions again, Ms Russell. Did you have any concerns that, so far as Scotland was concerned, there was an insufficient level of involvement in the production of this document?
Ms Gillian Russell: I didn’t have any concerns about it myself. As I’ve said before, I think the way in which people would generally have been influencing that would be through a huge infrastructure of sub-groups looking at different aspects of what sat as part of that National Security Risk Assessment. So we would be sitting on – or officials across government probably sat on quite a wide-ranging set of groups that would be looking at the evidence and analysis around that.
Counsel Inquiry: I appreciate that you were not still in office in 2022 and for the production of that National Security Risk Assessment. Are you able to, from your experience and knowledge in office, advise us as to whether or not the process of involving devolved administrations has changed at all in recent times since the production of the 2019 National Security Risk Assessment?
Ms Gillian Russell: I’m sorry, I’m not able to comment on that. I mean, what I would say is, going back to the start, you pulled up the table about what is devolved and what is reserved, and different administrations may take different views on how involved or not they would have devolved administrations and reserved matters.
So the national security reservation, yes, it’s a reserved matter, but, for example, the counterterrorism, the contest delivery is devolved to Scottish Government. So although the subject matter of national security is reserved, the delivery of the contest arrangements is devolved. So there’s always an interplay, and there’s probably always – there’s always differences of views about where some of the grey lines sit, if I can explain it like that.
Counsel Inquiry: All right.
Well, let’s take that down and look at the Scottish risk assessment. First of all, if we look at INQ000020678. This is the Scottish Risk Assessment End of Phase 2 Report, from March of 2017.
Ms Gillian Russell: Yeah.
Counsel Inquiry: Thank you. We can see at the bottom left-hand corner it’s a report that’s compiled by the SRA Project Team, sitting within the Resilience Division of Scottish Government.
Ms Gillian Russell: Correct.
Counsel Inquiry: Can you tell us about this report, please, and why it was commissioned?
Ms Gillian Russell: Yeah. So obviously we were embarking on, for the first time, a Scottish risk assessment process for Scotland, and I think it was really important, as we went through that process, that we were really stepping back and making sure that we were doing the right things, that we were getting the analysis right, that we had the right skills to do that work well. So this report was a report just looking at the process and how it was working and what it was starting to show in terms of Scottish Risk Assessment as opposed to that National Risk Assessment. So it took the national risks and it dropped it into that Scottish context.
Counsel Inquiry: Let’s have a look at page 3, please, where we can see a series of purposes and benefits set out. Thank you.
“The SRA will ensure there is an overarching Scottish perspective to risk which will enable us to improve how we protect our people, resources and assets, how we prevent and prepare for such incidents and how we respond to and recover from them should they occur. The SRA will be an evidence-based resource to inform multi-agency efforts to prevent, mitigate, and respond to disruptive challenges.”
Below:
“The work of the SRA will also enhance Scotland’s resilience partnerships’ existing risk work by ensuring national level information is provided for regional planning purposes.”
We know what the purpose was for introducing the Scottish Risk Assessment. Why do you think it hadn’t been used or implemented before?
Ms Gillian Russell: I think resilience was a maturing model in Scotland, so as that model matured and we were clearer about the philosophy and principles we were trying to embed across Scotland, I think it became apparent that a Scottish Risk Assessment would be a really helpful part of that overall package, because it would give you that strategic cut of the risk as it applied more for Scotland. So, I mean, just – you know, we’ve got 10% of the UK population in Scotland, but 30% of the land mass, and actually a very remote and rural country, with a lot of risk in that. So even just understanding the risk landscape, for Scotland it just helped to perhaps just focus slightly differently on how you would do the risk assessment when you moved from that UK level into that Scottish level, if that makes sense.
Counsel Inquiry: Had there been a change in culture towards risk in Scotland which meant that this was seen as an improvement for Scottish risk preparedness and resilience?
Ms Gillian Russell: I think there was just a general maturing of the whole approach to resilience and how you understand risk and mitigation, but also how you could use our understanding of risk to drive change in policies, substantive policies, so getting more into that preventative space.
Counsel Inquiry: How did this document and then the Scottish Risk Assessment of 2018 improve or advance the Scottish strategic objectives so far as preparedness and risk resilience is concerned?
Ms Gillian Russell: So I think that, well, one, the strategic risk assessment was much more – although it was a classified document, it was much more readily accessible to our responder community, so they could much more easily see the – that document, the National Risk Assessment, was quite a highly guarded document, so that – just actually sharing that knowledge and being able to work with partners with that knowledge was helpful.
It was used to then drop into the regional resilience partnership assessment of their risk, and they then produced risk assessments and plans against that which cascaded from the strategic risk assessment, so I think it was really helpful in that as well.
I think it did – as we worked with our policy colleagues in developing the risk assessment, it did help them to understand what were the mitigations or policies that they could do differently for the future, taking much better account of the underlying risk. So I think it generated a lot better understanding of underlying risk across government for the areas that we focused in on, if that makes sense.
Counsel Inquiry: Could we look at page 5, please. Thank you. Could we highlight the text above the pyramid, and just read through that.
Ms Gillian Russell: Yeah.
Counsel Inquiry: “A key objective for the [Scottish Risk Assessment] is that the individual risk assessments are robust and evidence based. In order to give assurance to this we have developed a process for challenge of the individual risk assessments and endorsement of the SRA development process. The model that we have developed provides the opportunity for academics and scientists, such as the Natural Hazards Partnership, to review the individual risk assessments and provide further guidance to fill any gaps in the evidence. Following this the Scottish Government Chief Scientific Adviser (CSA) will review the SRA process to help ensure that science has been considered and evidence analysed at appropriate times during the process. Subsequently the CSA will advise of improvements that can be made to the process and future iterations of the risk assessment. The following diagram shows the range of stakeholders we have engaged with at various points and how this fits with the model for verification and endorsement.”
Before we look at the model, what is the Natural Hazards Partnership that we see a reference to in the course of that paragraph? Thank you.
Ms Gillian Russell: So I actually can’t tell you what that partnership was. So I’m sure we can give you that information quite readily. I think the overarching – the overarching point on this paragraph is the fact that the assessment of risk needed to really take the views of everyone into account to try to make sure that we had lots of challenge and lots of people able to interrogate the risk assessments as they were being developed, and I think that was an important part of that whole process.
Counsel Inquiry: Let’s have a look at the pyramid, please, and if we can highlight it and zoom in on the wording. Thank you.
Ms Gillian Russell: Yeah.
Counsel Inquiry: We can see at the top we’ve got the Scottish Government and the Chief Scientific Adviser. Then, moving down the pyramid, we have the protection preparedness groups, we can see the Natural Hazards Partnership there, and a food standards adviser.
Then at the next level, multi-agency workshops and consultation, and then at the bottom we’ve got the various –
Ms Gillian Russell: Yeah, yeah.
Counsel Inquiry: – if we look at the left-hand side, what are described as policy inputs.
So moving from the bottom upwards, we can see we go from policy input to discuss and challenge, from review to endorse.
Ms Gillian Russell: Yeah.
Counsel Inquiry: Can you explain to us how this pyramid was expected to work.
Ms Gillian Russell: Yeah. So again, if we take just flooding as an example, because it’s sitting there as a natural hazard.
Counsel Inquiry: Yes.
Ms Gillian Russell: So there would be an initial look at the evidence and data and some policy input about what currently was being done to address flooding, what we could do moving forward.
That would then be taken into these workshops and consultation pieces. For us it said discussion and challenge, so the initial propositions would go there for consideration across those groups and, I mean, those groups are more actually your responder community groups, if you look at who is there, but the Chief Medical Officer’s there as well, obviously.
Then all of the thinking from the workshops and the consultation would come back for review and the Natural Hazards Partnership – I’m assuming it is the National Hazards – the people that are core for the national hazards work. So they would be looking at the policy input plus the discussion and challenge and then it would be brought together for an overall endorsement.
So it was an iterative process that was intended, I suppose, to really interrogate those risks and view those risks from lots of different standpoints.
Counsel Inquiry: It’s described as a model for verification and endorsement.
Ms Gillian Russell: Yeah.
Counsel Inquiry: From what you have described, the intention was to have challenge and to ensure that –
Ms Gillian Russell: Yeah.
Counsel Inquiry: – the policies that were being prepared and delivered were appropriate in –
Ms Gillian Russell: Yeah.
Counsel Inquiry: – the circumstances of whichever hazard or risk was being considered.
But when we look at the description of the organisations involved, they all appear to be state bodies, don’t they?
Ms Gillian Russell: Yeah.
Counsel Inquiry: Even the Chief Scientific Adviser, who we see in the second and top layer, is a government position. So where did the external challenge come from in this model?
Ms Gillian Russell: So at the very start, at the policy input stage, I would expect that the policies would be being discussed with stakeholders and external advisers at that point in time. In terms of discuss and challenge, I think what was being brought together were your people that would have that understanding of risk and resilience. So that’s – that would be the reason why we had that grouping there, and you see people like the Red Cross in there, Scottish Gas Networks, so they were the resilience community I think in its broadest sense reflected there.
Then at that next level up, the partnership grouping and the preparedness grouping, I would expect that there was a good representation of people on those review groups, finally going up for endorsement.
I mean, I suppose everything’s a learning process, isn’t it? So if it was felt through this process that we were not getting sufficient broader external views into that process, then certainly that’s something that could be built into it, for sure.
Ms Blackwell: Thank you.
My Lady, I’m moving on to a different topic. Is that a convenient moment to have our break?
Lady Hallett: Certainly. I shall return at 11.25.
Ms Blackwell: Thank you.
(11.11 am)
(A short break)
(11.25 am)
Lady Hallett: Ms Blackwell.
Ms Blackwell: Thank you, my Lady.
Thank you, Ms Russell. I’m going to ask that we look at the Scottish Risk Assessment from 2018. It’s at INQ000102940, thank you.
If we go to page 3, and look at the foreword, we can see there is a photograph, and indeed a signature, of John Swinney. This is, I think you said, the first Scottish Risk Assessment.
Ms Gillian Russell: Correct.
Counsel Inquiry: We looked just before the break at the document that brought this into force.
If we go to page 5, please, thank you, we can see the risk titles on this table at the lower part of the page, on the left-hand side, then there’s a risk IDS with a page reference and an overall assessment, and we see that the top risk here on this table is indeed pandemic influenza, with an overall assessment of very high.
Can you explain to us what the middle column refers to, the risk IDS, with a series of numbers for each of the risks, the letter H before each of them?
(Pause)
Counsel Inquiry: Does the H refer to hazard?
Ms Gillian Russell: Yeah, sorry.
Counsel Inquiry: And then the number of the hazard, and is the S at the end of the description a reference to Scotland?
Ms Gillian Russell: Yes, yeah. Yeah. So they would have been the hazards that we had chosen to focus on, because obviously we just took for this strategic risk assessment a number of risks, we didn’t take the whole set of risks.
Counsel Inquiry: Right. Can you confirm that, so far as this risk assessment is concerned, it uses the same methodology as the National Risk Assessment –
Ms Gillian Russell: Yes.
Counsel Inquiry: – from which it’s taken?
Ms Gillian Russell: Yeah, yeah.
Counsel Inquiry: Yes. Let’s look at page 6, please, because I think we can see here a helpful explanation of where the Scottish Risk Assessment fits in with the United Kingdom National Risk Assessment.
On the left-hand side, in the text, we see this:
“At a regional level resilience partners should use the Risk and Preparedness Assessment … process to help understand the risks that are relevant to each region and to plan and prepare based on that information. The SRA provides a Scottish context to resilience partners on the types of emergencies Scotland may face and makes the most relevant information available to them when completing their RPAs.
“As a strategic tool, the SRA does not replace or replicate more detailed risk assessment products and evidence, whether that be detailed intelligence threat assessments or short term hazards forecasts.
“The information in this document, alongside the NRA, can also be used to support investment or resource allocation on the basis of risk prioritisation. However, it should be used as a guide only and such decisions must necessarily reflect other factors such as risk tolerance, capability gaps, mitigation options, affordability and a wider cost/benefit analysis.”
So the intention was for the Scottish Risk Assessment to be used in conjunction with but not as a substitute for the National Risk Assessment?
Ms Gillian Russell: Yeah.
Counsel Inquiry: We can see on the right-hand side “UK National Risk Assessment”. It’s split into “Hazards” and “Threats”, and we can see that the “Scottish Risk Assessment Hazard scenarios specific to Scotland” then cascades down to the “Regional Risk and Preparedness Assessment”.
So it was intended that both the Scottish and the National Risk Assessment be used by the regions and the local resilience partnerships to prepare their own risk assessments and to utilise the information?
Ms Gillian Russell: Yeah. The regional resilience partnerships primarily were doing that kind of supra-assessment. I think there are some examples of that in the evidence.
Counsel Inquiry: All right. Let’s go to page 41, please, which deals with the influenza pandemic.
We can see the now familiar table in the right-hand corner, based upon an assessment of impact and likelihood, and we can see where the reasonable worst-case scenario appears in the top right-hand corner of the chart.
If we scroll out, please, we can see down the left-hand side of this page, under “Outcome Description” that: each wave of the pandemic may last between 12 and 15 weeks, that up to 50% of the population could experience symptoms, and we can see approximately 2.7 million in Scotland; up to 4% of symptomatic patients, approximately 110,000 people, could require hospital care; up to 2.5% of those with symptoms could die. Then there’s the bottom bullet point:
“[When] combining these figures … it is relatively unlikely to have both high end illness and death rates resulting in around 68,000 deaths, this is the advised reasonable worst case for guiding planning in Scotland.”
Was this assessment based entirely upon the science which had been provided for the National Risk Assessment? In other words, was there any separate Scottish science that was relied upon in order to arrive at these figures?
Ms Gillian Russell: So my understanding was that on the pandemic risk, there was a UK assessment of what that – the most likely risk was around the pandemic flu.
Counsel Inquiry: Yes.
Ms Gillian Russell: And that – that there was no reason not to – to depart from that for Scotland. So what you’re seeing here is what that national risk would have looked like around pandemic flu planning as being the most likely scenario.
Which I appreciate is not what the pandemic was, but I think the Scottish assessment was no different, if that’s the question you’re asking.
Counsel Inquiry: Well, the question I’m asking is: does this demonstrate that all that happened was the population figures of Scotland were replaced in what was an assessment provided in the National Risk Assessment; the only difference between the two –
Ms Gillian Russell: Yeah.
Counsel Inquiry: – is that the Scottish population figures have been replaced –
Ms Gillian Russell: So I suppose if you – taking it back a step, when we were preparing the Scottish Risk Assessment, we were doing that in the context of understanding what the National Risk Assessment was saying, and so unless there was some good reason you might want to depart from that when you were translating that into a Scottish context, we would have been taking that National Risk Assessment and moving it into a Scottish context.
So that scenario, on the left, is the one that I recognise, is the one that the Chief Medical Officers and others were content was the most likely scenario that we should be planning against.
Counsel Inquiry: Well, was there any involvement from the Scottish scientists that were advising the government? Was any of that process undertaken, or was this simply a case of putting the Scottish population figures into the National Risk Assessment?
Ms Gillian Russell: So I can’t answer that question. I think you would need to ask that of others about the exact evidence that was taken in relation to this particular risk. As I understand it, that risk was looked at for Scotland and the assumptions were made that really mirrored what the assumptions looked like for the UK but for a Scottish population.
Counsel Inquiry: So you can’t tell us, for instance, whether Scotland’s Chief Scientific Adviser or anybody on the Natural Hazards Partnership took into account any of the background analysis that had been undertaken for the National Risk Assessment, on behalf of Scotland?
Ms Gillian Russell: So what I would say is that process was followed for this risk, and the work that was done by those people would have informed the outcome on that risk. So insofar as there was scientific evidence used, it would have been the risk, as it was eventually arrived at, was informed by that, through that process.
Counsel Inquiry: What does that mean, that it was informed by that through the process?
Ms Gillian Russell: Well, I think before the break you’d set out how we had worked through these risk assessments for this Scottish Risk Assessment, and that process would have been followed across the risks that we arrived at for the Scottish Risk Assessment.
So I suppose what would be – what would have – where would the science have been that would have suggested that you would have had a different – a different nature of planning assumption or risk assessment for pandemic flu in Scotland as opposed to what was being done at national level, when we broadly had a four nations approach to planning for pandemic flu.
Counsel Inquiry: Right.
Lady Hallett: I’m sorry, I still didn’t follow, Ms Blackwell.
Can I ask you this, Ms Russell: surely if you’re going to make it a Scottish-specific risk assessment, taking the overall analysis of the risk assessment, shouldn’t you factor in other Scottish specific factors such as – you said earlier about the 30% land mass and how the population is distributed, you wouldn’t just take the population figures and scale back down, would you? Would you not take into account other factors?
Ms Gillian Russell: I think in terms of the – if I look at the outcome description here, the view was that there would be waves of pandemic flu that would affect up to – would create up to 30% absence over – over time, and there was nothing to suggest that that wouldn’t also be the case for Scotland.
Lady Hallett: So you don’t think it’s necessary to take into account other specific Scottish factors?
Ms Gillian Russell: Well –
Lady Hallett: I mean, you may be right, I’m just asking.
Ms Gillian Russell: Yes, so I suppose on the scenario that was presented for pandemic flu, which was about allowing a flu pandemic to effectively move through your population, that was the – that was the – that’s the basis on which this scenario was developed. What we understood from that was that you would be – that you would have waves of illness going through your population with consequent staff absence across your – across all sectors of your society, and that was the scenario.
So there wasn’t necessarily a different – a different Scottish aspect of that particular scenario in terms of what we – what was being modelled in terms of the impact of the waves of flu pandemic across your population.
Lady Hallett: Thank you.
Ms Blackwell: Thank you.
Can we move to page 50, please, and look at – thank you – the emerging influenza-type disease. I’m sorry, the emerging infectious disease scenario, thank you. We can see on the top right-hand corner again the familiar chart. Impact versus likelihood, and we can see the position at which emerging infectious diseases are placed in terms of the reasonable worst-case scenario.
We don’t need to go there, but we know that in relation to this assessment there were low confidence levels, weren’t there, Ms Russell?
Ms Gillian Russell: Yes.
Counsel Inquiry: Yes, and unlike the National Risk Assessment, which indicates the wide range of variants that the emerging infectious disease could bring by the positioning of arrows at the top right-hand and bottom left-hand side of the chart, there are no arrows on this chart to indicate that there is a low confidence level. Can you explain why that is?
Ms Gillian Russell: No, I’m sorry, I can’t. That’s the document as it stands, so I can’t give any explanation for that.
Counsel Inquiry: All right. Perhaps we don’t need to look at it, and you’ll take it from me, that in relation to the level of fatalities and casualties for Scotland that were assessed as being pertinent to this particular risk, they are the same – in the same brackets and in relation to the same percentages as are taken from the National Risk Assessment, and, again, it appears that all that’s happened is that the Scottish population figures have been replaced into the National Risk Assessment scenario and analysis; do you agree with that?
Ms Gillian Russell: Yes, and – but that would have been done on the basis of advice that that was an appropriate way to look at this particular risk, moving from the national to the Scottish Risk Assessment.
Counsel Inquiry: But who was providing that advice?
Ms Gillian Russell: The advice would have come from a range of people that were looking at that risk.
Counsel Inquiry: Who are they? Who are the people who would have been providing the Scottish advice?
Ms Gillian Russell: So I can’t give you those names, so perhaps we could come back to that.
Counsel Inquiry: No, but the positions. Positions.
Ms Gillian Russell: Yeah. So we would have had – we would have had the range of people that had the specialist knowledge in those areas to do that for us, and certainly, you know, I worked with the Deputy Chief Medical Officer when we were ensuring that people were aware of this risk, and it was something that at that point in time he was content with. So, I’m sorry, you’re going to push me, but I can’t answer your question any more than I have done already, so I can undertake to come back to the Inquiry with further information on that.
Counsel Inquiry: Right. Was there any additional analysis undertaken in relation to these two risk assessments for pandemic influenza and emerging infectious disease other than replacing the UK-wide population figures with the Scottish population figures?
Ms Gillian Russell: Again, could I come back to you on that, please?
Counsel Inquiry: All right.
Let’s take that down, please.
Community risk registers. A community risk register, according to the witness statement of Mr Thomson, is a multi-agency publication created as an output of the risk preparedness process.
How were community risk registers used in conjunction with the risk assessments that we’ve just seen?
Ms Gillian Russell: So, sorry, could you just run past that question again, and give me a reference to community risk registers? Thanks.
Counsel Inquiry: The community risk register, was it held at a local or a regional level?
Ms Gillian Russell: So there would have been the regional risk assessments that were done by the regional resilience partnerships.
Counsel Inquiry: Yes.
Ms Gillian Russell: So they did those assessments, and there was a risk process attached to that and a continuous approvement approach to that.
LRPs may well have held their own community risk registers, but that would be a matter for those LRPs to consider and look at what they needed to be focusing on at that local level, and we would have expected the regional resilience partnerships to then be having a look across the local resilience partnership arrangements.
Counsel Inquiry: How did you ensure that there was good risk assessment procedure in place on a regional and a local level in terms of pandemic influenza and emerging infectious diseases?
Ms Gillian Russell: So those – those matters would have been referred to in the resilience planning and then down into the local resilience planning. In terms of how that then fed back up, I think I’d explained earlier that the fire service did some assessment of the regional resilience assessments and looked for areas where there were gaps and things that needed to be improved. So that was a whole kind of continuous improvement process around that.
In terms of understanding at national level, there was a set of – there was a set of national actions that were taken forward as a result of the emergency planning exercises around the pandemic, and there was also, from 2017 onwards, a four nations approach that was taken forward from a decision of the National Security Council, and Scotland played their part in that.
Counsel Inquiry: Just remaining at a local and regional level for a moment, who had the level of assurance? Who was looking at what the regional partnerships and the local partnerships were doing and ensuring that their level of local preparation for the risks which we see identified in the Scottish Risk Assessment were being properly dealt with and maintained?
Ms Gillian Russell: So I think under the Civil Contingencies Act ultimately duties do sit on first and second responders, so decision-making and making sure that business continuity planning and all of the things that needed to be in place at local level ultimately were for those first responders and second responders to have oversight on, and so we would expect – you know, it’s back to that subsidiarity principle, we would expect, through the arrangements we put in place, that there was an ability at local, then regional, then national level to be able to do that planning effectively. Because obviously you might have, you know, 30 local plans coming up to your resilience – regional resilience partnership, looking at those three blocks and the things that they were picking out. The strategic resilience partnership that I spoke about before the break, pandemic flu did come to them as a topic, and they did – and the resilience – regional resilience partners sat on that forum along with the first responders, and there was a discussion based on the strategic risk assessment at that forum with those strategic leaders to have a look at, you know, what – did we feel we were ready for a pandemic, what further work needed to be done to improve the response. And there was – some actions came out of that meeting.
Counsel Inquiry: When did that meeting take place?
Ms Gillian Russell: That meeting took place in, I think, 2018.
Counsel Inquiry: Was the conclusion that you were ready for a pandemic?
Ms Gillian Russell: So the conclusion from that meeting was there was more work to be done, and that, you know, all of the responders at that meeting said they needed to go back and have another look at their plans and see – make – I think there was a – at that meeting there was a: you can plan, but actually let’s make sure we’re really understanding what this modelling is telling us” – and remember it’s not the pandemic that came to pass, it was the pandemic that we were planning for as a central assumption – make sure that we have got what we need in place to address that. And I think I did pick that up in my statement.
Counsel Inquiry: Well, I want to take you to a set of minutes from June of 2019 from the Strategic Resilience Partnership.
Ms Gillian Russell: Yeah.
Counsel Inquiry: But to put it in context, first of all, by the time this meeting took place there had been Exercise Silver Swan in April of 2016?
Ms Gillian Russell: Yeah.
Counsel Inquiry: As we know, that was an exercise that took place in Scotland.
Ms Gillian Russell: Yeah.
Counsel Inquiry: It was focused on four specific areas: health and social care, excess deaths, business continuity, and overall co-ordination. Out of that exercise were a series of recommendations about pandemic planning, about the co-ordination of the response, about supply chain interdependencies, and about PPE.
Those recommendations were themselves considered at a progress review event for Silver Swan that took place in December of 2016, didn’t it?
Ms Gillian Russell: Yeah.
Counsel Inquiry: Were you present at that?
Ms Gillian Russell: I wasn’t, no.
Counsel Inquiry: No. We know that the Deputy Chief Medical Officer, Mr Gregor Smith – Dr Gregor Smith, sorry, was present there.
Ms Gillian Russell: Yeah.
Counsel Inquiry: You will be familiar, though, with the outcome of that review?
Ms Gillian Russell: Yeah.
Counsel Inquiry: Yes. In general terms, there was still progress to be made on all of the areas of recommendation, wasn’t there?
Ms Gillian Russell: Yeah, yeah, correct.
Counsel Inquiry: So nothing in that six months had been completely –
Ms Gillian Russell: Signed off, no.
Counsel Inquiry: – signed off?
Ms Gillian Russell: No.
Counsel Inquiry: Right.
We then had Operation Cygnus. Were you involved in Exercise Cygnus?
Ms Gillian Russell: Officials within the directorate would have been involved, but I personally wasn’t involved.
Counsel Inquiry: All right. There were a series of recommendations that flowed from that exercise, and those matters were also considered by the Strategic Resilience Partnership, weren’t they?
Ms Gillian Russell: Correct, yeah.
Counsel Inquiry: Some of those recommendations covered the same areas as Silver Swan, some of them covered new areas, such as developing a pandemic Concept of Operations, and other matters involving capacity –
Ms Gillian Russell: Yeah.
Counsel Inquiry: – surge capacity, those matters that were considered, I’m going to suggest, in two meetings of the Strategic Resilience Partnership in October of 2017 and then in April of 2018?
Ms Gillian Russell: Yeah, yeah.
Counsel Inquiry: Still the recommendations had not been fully implemented, had they?
Ms Gillian Russell: By 20 – no, they hadn’t.
Counsel Inquiry: By 2018?
Ms Gillian Russell: They were in progress, though.
Counsel Inquiry: They were in progress?
Ms Gillian Russell: Yeah.
Counsel Inquiry: Because when we come to the meeting in June of 2019 – and I am going to ask that we look at the minutes of this meeting, please, at 2078287(sic), thank you, and if we can go to page 9, please.
Thank you. Can we zoom in on the first box on that page. Here we see, in relation to health and social care:
“Update April/May 2019”
This meeting, I remind ourselves, was June of 2019, so this was the most up-to-date information.
“Further work on pan flu operational guidance for health & social care in Scotland had been paused due to internal pressures and anticipation of the UK Pan Flu Strategy review … now being progressed. Draft to be shared with pandemic flu contacts at Boards in June 2019, the Board pan flu co-ordinators group is being convened to consider the guidance.
“UK-wide Pandemic Flu Strategy – had been due for review by Spring 2019 and would naturally inform the operational guidance for Scotland. However, work paused at [UK Government] level and timescales for progressing work on Strategy unclear.
“[United Kingdom Government] work on finalising/disseminating options for response in the adult social care and community healthcare sectors also paused – will help to inform future iterations of Scottish operational guidance.”
So having had recommendations from Silver Swan in 2016 that the Scottish Government should review its national plans and also recommendations from Exercise Cygnus following from that, it would appear that those areas of improvement, recommendations in relation to that, were still, in June of 2019, in the process of being dealt with, had not been completed, and in fact work on them had now been paused?
Ms Gillian Russell: Yeah, yeah. That’s correct, yeah.
Counsel Inquiry: Why was that?
Ms Gillian Russell: So some of the work did continue. What happened in October 2018 was we were presented with the Yellowhammer planning assumptions for no-deal Brexit, and they were very, very significantly challenging, and a decision was taken that priority should be given to working through how we would mitigate the very significant risks that would immediately crystallise on a no-deal Brexit, and that took up a huge amount of strategic capacity across many parts of Scottish Government, including the resilience co-ordination of a lot of that work.
We still did take forward some of the work, so we took forward the work on communications around a pandemic, and that work was issued in 2019. We took forward the general work around how we would work well together as a system, and I think I’ve tried to explain the resilience partnership and the various work that was done with the regional resilience partnerships to strengthen all of the way that the resilience – the resilience system worked effectively. So that work had been largely done, and there was a whole series of work that had been done on excess deaths and that work was also completed.
However, as you rightly point out, the work that sits here has – was paused and not taken forward because priority was given to other things.
Counsel Inquiry: Well, following the recommendations in Exercise Cygnus in 2017, the Scottish Government pandemic flu preparedness board was set up, wasn’t it?
Ms Gillian Russell: Yeah, yeah, yeah.
Counsel Inquiry: That mirrored the work of the United Kingdom Pandemic Flu Readiness Board, the PFRB?
Ms Gillian Russell: Yeah.
Counsel Inquiry: When was the Scottish version of that preparedness board set up? When did it start to work?
Ms Gillian Russell: So that board sat over that period – I’m sorry, I don’t have the dates when it started to hand, but it mirrored, as you say, the UK arrangements and it sat through that period.
Counsel Inquiry: How many times did it meet from its inception until the onset of Covid?
Ms Gillian Russell: So it met – we had – we had regular and good meetings for a period, but from October 2018 that was much more sporadic.
Counsel Inquiry: So how many times did it meet until you were asked to pause the work for Operation Yellowhammer?
Ms Gillian Russell: So I can’t give you that answer, I’m sorry. I would need to look at my papers to tell you that answer.
Counsel Inquiry: What level of work was completed by the board before it was paused in 2018?
Ms Gillian Russell: So, as I said, I think the work that was taken forward within the Resilience Division was progressed and we managed to get to a conclusion on that. There was a range of other work that was not completed. And, you know, that’s a matter of evidence, and I think I’ve shared with the Inquiry a table setting out where those various strands of work got to.
Counsel Inquiry: Yes, the table that you’ve shared with us today –
Ms Gillian Russell: Yeah.
Counsel Inquiry: – has been created since the Covid pandemic hit, hasn’t it?
Ms Gillian Russell: Yeah, yeah, yeah, yeah.
Counsel Inquiry: There are still areas of work outstanding from the recommendations –
Ms Gillian Russell: Yeah.
Counsel Inquiry: – that were made way back in 2016, aren’t there?
Ms Gillian Russell: There are – I mean, there was work that was progressed but had to stop because of the pandemic itself, so yes, there’s some work that was not taken forward because of the pandemic itself.
Counsel Inquiry: So the point I’m getting at, Ms Russell, is: even as far back as the Silver Swan recommendations, but also moving forwards through the Exercise Cygnus recommendations, there are still, now, outstanding areas of work, aren’t there? There are still recommendations which haven’t been implemented?
Ms Gillian Russell: Or recommendations that may have been superseded by the pandemic itself. But I think yes, you’re right, there are still areas of work that would need to be – you know, further work done on, you’re right.
Counsel Inquiry: When you say that work had to be paused because of the preparations for a no-deal Brexit – a no-deal EU exit, was that everything that the flu pandemic preparedness board was working on, or were there still some workstreams that were worked on even through 2018 and into 2019?
Ms Gillian Russell: So we were taking a four nations approach, so the decision –
Counsel Inquiry: What does that mean?
Ms Gillian Russell: It was being – so Scotland was part of an approach led by the United Kingdom Government to do the pan flu preparations, so there’s a range of work that the United Kingdom Government had agreed through the National Security Council that we should, on a four nations basis, take part in, and that was fine and we progressed that work up to a point. The work then that was continued to be taken forward, the only piece of work that was agreed to be continued to be taken forward post October 2018, when that pause was made on a four nations basis, was the legislative work. So there was work to put in place an emergency provisions Bill in the case of a pandemic flu, and that work did continue, and we continued to contribute to that work.
There was work that we continued to do based on the recommendations that had come out of Cygnus and Silver Swan. So, as I’ve said, we continued with all the communications work and that piece of work was published, we continued with the excess deaths work and we’d got that to a satisfactory position. In terms of the material that’s sitting on the screen in front of me, which was the overall strategy which was due to be reviewed, that was the thing that was not progressed.
Counsel Inquiry: But that wasn’t the only thing that wasn’t progressed, was it?
Ms Gillian Russell: Yeah, yeah.
Counsel Inquiry: If we look at page 12, please, thank you, and can we zoom in on the table at the top of the page, and go from left to right.
The “Provision Description” is:
“Closure of Schools and colleges”
To be included in Scottish Government clause: yes.
Scottish Government policy instructions drafted:
“Colleges remain outstanding.”
And then the “Notes”:
“OPC in process of making final amendments to draft clauses for school closures.
“Colleges: separate clauses required for colleges.
“Note: Universities … are out with scope.”
Then we see another column with a “Green” indication and then an “Amber” one underneath.
Ms Gillian Russell: Yeah.
Counsel Inquiry: Then last position:
“Schools: to be completed by 10th June 2019.”
Was that done?
Ms Gillian Russell: I can’t – I can’t tell you whether that was completed or not.
Counsel Inquiry: And “Colleges”:
“Policy area failed to engage despite repeatedly correspondence. Issue to escalated further urgently.”
Ms Gillian Russell: Yeah.
Counsel Inquiry: I’m not sure that either of those sentences make sense, but what does that mean?
Ms Gillian Russell: So when the legislation was being done by the United Kingdom Government for – to have on the stocks and emergency Bill, there were parts of Scottish Government that wanted more time to think through the policy implications of what was being instructed, and at times it was difficult to get that engagement. So that was a fair reflection on the fact that that area was outstanding as an area that had not provided the policy instructions that were needed to finish the drafting of that Bill.
Counsel Inquiry: So was this piece of work one which was paused or had it been completed by the time that Covid hit?
Ms Gillian Russell: So that piece of – the piece of legal work that was ongoing, as I understood it, that emergency legislation was being finalised over that period.
Counsel Inquiry: Was it finalised?
Ms Gillian Russell: I can’t tell you whether it was completely finalised.
Counsel Inquiry: Right.
Can we go to page 17, please. Thank you.
We can see towards the bottom of this page there is a reference to the Pandemic Flu Readiness Board, and we can see at item number 10:
“In summer 2017, the Deputy First Minister commissioned a new SG Pandemic Flu Readiness Board (PFRB) with cross-cutting [Scottish Government] membership to lead on Scotland’s interests at UK level and further develop preparedness in Scotland.”
Number 11:
“The PFRB agreed to operate a programme of 6 workstreams (compared to 5 UK workstreams) which extend across portfolios of responsibility. These are:
“Health and social care ([including] Moral and Ethical)
“Legislative
“Excess Deaths
“Sector Resilience
“Communications
“SG [Scottish Government] Preparedness”
Ms Gillian Russell: Yeah.
Counsel Inquiry: Thank you. If we can go back to the full page:
“Since the project inception [we’re now at number 12] a number of activities across workstreams have been developed which have improved the overall state of pandemic flu readiness across Scotland, and other UK nations. An overview of which is provided in table at [paragraph] 18.”
If we go to the following paragraph, number 13:
“PFRB met approximately every 2 months up until November 2018 however recent meetings have been cancelled/postponed due to availability and competing priorities. The board last met on 13 November 2018 and is due to meet next on 5 June 2019.”
So it looks as if, although the board was originally meeting every two months –
Ms Gillian Russell: Yeah.
Counsel Inquiry: – that frequency was paused in November of 2018. Is that, do you say, due to the preparations being made for a no-deal EU exit?
Ms Gillian Russell: So the people that were – so there’s a huge cross-government effort needed to respond to the Yellowhammer planning assumptions, which were really significant and required huge amounts of detailed work to understand, and put mitigations in place. So that explains why the capacity was placed on something other than this, and those meetings were not of the same frequency.
Counsel Inquiry: Can I just remind ourselves, though, of what this sentence said:
“… recent meetings have been cancelled/postponed due to availability and competing priorities.”
Ms Gillian Russell: Yeah. Yeah, that was no-deal Brexit.
Counsel Inquiry: So the board didn’t meet from November of 2018 until June of 2019?
Ms Gillian Russell: That’s correct.
Counsel Inquiry: What happened when it began to meet again in June 2019?
Ms Gillian Russell: So I think there was only one further meeting of the board, as I recollect, but, looking back at your list, those workstreams had broadly progressed. I think a number of those workstreams had got to a concluded point throughout the period of 2019, including our own internal preparedness. There had been quite a lot of work done internally within Scottish Government including incorporating pandemic risk assessment into our internal assurance processes. There was an internal audit done on some of the work that we’d carried out for review. There was – there was a familiarisation process across directorates on the planning assumptions for pandemic flu, and familiarisation to ensure that people were understanding the sorts of things that needed to be considered for their own policy areas. So –
Counsel Inquiry: Was there a problem with resourcing?
Ms Gillian Russell: There wasn’t a – there’s a finite resource in government, and there’s a finite resource of people with certain skills and expertise. So, as an example, if all of your skills and expertise on understanding the flow of drugs into Scotland and the sort of issues that might arise if you did not get those drugs through because of a no-deal Brexit required the people that might have been looking at drug supply for some other reason, then those people were going to be looking at the no-deal Brexit set of issues. And there was a lot of work across government to try to mitigate and understand the nature of those risks. I mean, that’s just – I’m just being honest, that is what happened.
Counsel Inquiry: All right.
Ms Gillian Russell: Whether the Inquiry thinks that’s right or not is for the Inquiry, but I’m just being honest about what happened to the way that resource had to be prioritised after that period.
Counsel Inquiry: I just want to look at two further paragraphs of these notes, paragraph 17, please, which is on the following page, thank you:
“The [Health and Social Care], Communications and [Scottish Government] Preparedness workstreams are primarily being taken forward by staff as part of their business area roles and responsibilities. No additional staff resource(s) are required to complete outstanding tasks and actions. Workstream leads have however suggested they should remain part of current project governance arrangements and the focus of the PFPB [that should be RB] / to help ensure outstanding work is fully completed.”
If we, finally, look at paragraph 34, which is on page 23 – thank you.
“Outstanding Areas of Work:
“34) Where possible workstream activities are being completed and/or migrated over to [Scottish Government] teams as part of business as usual. Work on Legislation; [Health and Social Care] Guidance; Communications, Scottish Government Preparedness and the review of the 2011 UK Pandemic Flu Strategy remains outstanding. Details of work to be undertaken/completed is provided at Annex B …”
Ms Gillian Russell: Yeah.
Counsel Inquiry: So as of June of 2019 and the decision made, it appears, during the course of this meeting, was that any outstanding areas of work were to be folded into business as usual?
Ms Gillian Russell: Yeah, and the work on legislation did continue, the communications work was completed as business as usual, and the Scottish Government preparedness work did get done as well.
Health and social care guidance, I can’t speak to that. There was a whole – there was the health and social care team that would have dealt with that, and the overall review of the 2011 pandemic flu strategy remained outstanding. So that wasn’t incorporated into business as usual, as I understand it, because it didn’t get – that did not get done. But other things –
Counsel Inquiry: No.
Ms Gillian Russell: – that were incorporated into business as usual did.
Counsel Inquiry: It was a disappointing response, wasn’t it, to the recommendations from both Silver Swan and Cygnus?
Ms Gillian Russell: It was disappointing, but other factors came into play as well, so I accept that you would call that disappointing overall, yeah.
Ms Blackwell: Right, thank you.
My Lady, that completes my questioning for this witness.
Questions From the Chair
Lady Hallett: Could I just have one question.
Going back to the issue of prevention, I have heard from a number of witnesses, Ms Russell, about the importance of prevention in pandemic planning. I mean, obviously there may well be references to prevention in these documents and I just wondered if you could help me as to what kind of emphasis was placed on prevention of the pandemic, as opposed to dealing with the consequences, in the planning with which you were involved?
Ms Gillian Russell: So in terms of prevention itself, I would say that was not something that was particularly in focus. I mean, obviously there’s the sort of primary, secondary, tertiary preparation and some of the resilience community if they talk about prevention might mean something quite tactical. When I talk about prevention, I would be talking about early years development or much broader issues around how to address health inequalities in a sort of preventative sense, but from what I understand you’re asking around prevention, is there anything particular you have in your mind, my Lady?
Lady Hallett: No, just a focus on prevention, and I thought your answer was there wasn’t a particular focus on prevention.
Ms Gillian Russell: I wouldn’t say in the way that you’ve asked for it. I mean, you can see from the document and the discussions it was more about mitigating the consequences.
Lady Hallett: Thank you.
Ms Blackwell: My Lady, provisional permission has been given to Scottish Covid Bereaved to ask a question based around the planning and performance directorate. May permission be given, please? I understand that Ms Mitchell King’s Counsel is ready to ask that question.
Lady Hallett: Certainly.
Ms Blackwell: Thank you.
Lady Hallett: Ms Mitchell.
Questions From Ms Mitchell KC
Ms Mitchell: I’m obliged.
You’ve explained the use of directorates this morning, providing a more flexible approach. Can I just ask: some of the witnesses have referred in their statements to the planning and performance directorate; can I be clear, is that now the Performance, Delivery and Resilience Directorate?
Ms Gillian Russell: Yes.
Ms Mitchell KC: Can you tell me when it changed?
Ms Gillian Russell: So it changed after I had left my role. So, I’m sorry, I can’t really comment on that further. Perhaps somebody else would be able to give you more information on that.
Ms Mitchell KC: I’m sure we’ll try and find that out.
Can you explain to us what your role would be in that directorate?
Ms Gillian Russell: I didn’t – I was never in that directorate.
Ms Mitchell KC: Can you explain, then, the role of the people who were in that directorate?
Ms Gillian Russell: In the new directorate are you referring to?
Ms Mitchell KC: No, the original directorate.
Ms Gillian Russell: The Safer Communities Directorate?
Ms Mitchell KC: Indeed.
Ms Gillian Russell: So I was the director of the Safer Communities Directorate from 2015 to 2020, so I had wide-ranging responsibilities there as the director, including responsibility for the police and fire service, for areas around reducing crime, for counterterrorism, national security, and resilience was a part of that overall set of issues that I had responsibility for.
Ms Mitchell KC: Did you interact with any other directorates during that time, specifically the performance – the planning and performance directorate?
Ms Gillian Russell: So that directorate didn’t exist in that form when I was the director of Safer Communities, and as the resilience director I would really engage across all of the directorates in government, because often each directorate would have an interest in relevance at different points in time.
Ms Mitchell KC: That’s really what I’m getting at.
Ms Gillian Russell: Okay.
Ms Mitchell KC: So what was the directorate, if any – or what was the name of the body that was responsible for that within government that’s now the Performance, Delivery and Resilience, or the planning and performance directorate? Which body was that –
Ms Gillian Russell: Are you talking about the part of government that – are you getting at – that co-ordinated across government for resilience?
Ms Mitchell KC: Indeed.
Ms Gillian Russell: Ah, okay, yes. So that was the directorate that I had responsibility for, yeah.
Ms Mitchell KC: So you had responsibility for ensuring effective planning, preparation, on how to respond and recover from incidents as a government?
Ms Gillian Russell: So the actual responsibility for consequence planning sat with individual directorates, so on the health side of government they had their own resilience function, so although I had overarching responsibility for resilience, the policies would sit within the different directorates. So Health and Social Care would have a big interest in the pandemic flu risk because clearly it had big implications for the health and social care system that they would have been working through.
Ms Mitchell KC: We have a statement from Caroline Lamb, who the Inquiry will no doubt hear from. I don’t need this brought up, but just for information, it’s INQ000184897, page 44, paragraph 155.
What she explains is that during the period:
“Between 11 June 2009 and 21 January 2020, the Planning and Performance Directorate did not carry out [any] direct forecasting for a pandemic.”
Was that anything that you were aware of?
Ms Gillian Russell: Could you just re – I’m sorry, apologies.
Ms Mitchell KC: Yes, certainly.
“Between 11 June 2009 and 21 January 2020, the Planning and Performance Directorate did not carry out direct forecasting for a pandemic.”
Is that as you understand it?
Ms Gillian Russell: So, that – that directorate didn’t exist in that form over that period, so I’m – I wonder what Caroline’s getting at, you need to ask her herself, whether what she means is that they were prospectively doing some of that. Because there was definitely planning work, obviously, I’ve talked about the planning assumptions that were made around a pandemic and familiarisation of that across government.
Ms Mitchell KC: Yes.
Ms Gillian Russell: It may be that she’s talking about a kind of more technical thing that that directorate now does. But certainly the actual planning assumptions around the pandemic that was being planned for, which I, you know, fully recognise as not the pandemic that happened, those planning assumptions were very well understood across government.
Ms Mitchell KC: Well, that’s hopefully helpful and perhaps we can ask Ms Lamb more about that.
Ms Gillian Russell: Okay.
Ms Mitchell: Thank you.
Lady Hallett: Thank you, Ms Mitchell.
Ms Blackwell: My Lady, that concludes Ms Russell’s evidence.
Lady Hallett: Thank you very much, Ms Russell.
The Witness: Thank you. Thank you.
(The witness withdrew)
Lady Hallett: Can I ask what time people wish me to – do I break now or do I go to the next witness?
Mr Keith: We have another witness now. It may be helpful, my Lady, if we could at least break the back of the evidence before lunch.
Lady Hallett: Of course. Whatever suits everybody else.
Mr Keith: May we have Caroline Lamb, please.
My Lady, whilst Ms Lamb finds her way to the witness box, may I just make a correction arising out of the evidence yesterday, for the record.
You will recall that Covid-19 Bereaved Families for Justice Cymru passed a note stating that, in their opinion, Mr Hancock had not been correct when he had said in evidence:
“It’s the first known coronavirus that affects humans that can be transmitted asymptomatically, and the WHO assumption was that this wasn’t possible until April 2020.”
I made a submission to you to the effect that the chart of epidemics showed in fact that, in relation to both MERS and SARS, there was asymptomatic transmission. I was incorrect, and I apologise. Based on information I was given I said that they were both asymptomatic. The correct position, which I’m happy to correct, is that the chart showed that in relation to MERS, and whether there was widespread asymptomatic transmission, the position is: not initially, but more reports over time. And in relation to SARS there was no widespread asymptomatic transmission.
Lady Hallett: Thank you.
Mr Keith: Could Ms Lamb be sworn, please.
Ms Caroline Lamb
MS CAROLINE LAMB (affirmed).
Questions From Lead Counsel to the Inquiry
Mr Keith: Could you give the Inquiry your full name, please.
Ms Caroline Lamb: Yes, Caroline Sarah Lamb.
Lead Inquiry: Thank you very much for your assistance in this Inquiry, Ms Lamb.
As you give evidence, could you please remember to keep your voice up so that we may clearly hear you and so that your evidence can be recorded by our hard working stenographer.
You’ve provided two corporate witness statements; is that correct?
Ms Caroline Lamb: That is correct.
Lead Inquiry: Both of which I know you’ve signed and both of which contain a statement of truth.
Ms Lamb, are you currently the Director General for Health and Social Care and also the Chief Executive of NHS Scotland?
Ms Caroline Lamb: I am, and would it be possible for me to just say a few words in that capacity?
Lead Inquiry: Of course.
Ms Caroline Lamb: Thank you. Just before we start, I’d like personally, but also on behalf of NHS Scotland and the Director General for Health and Social Care at the Scottish Government, to express my condolences to everybody who was affected by the Covid-19 pandemic. I’d like to affirm our commitment to learning from this Inquiry, and I’d also like to express my huge thanks to all those who worked across health and social care, and indeed our partners in local government, in the third sector, everybody who contributed towards helping to support the people in Scotland through the pandemic. Thank you.
Lead Inquiry: Are you the most senior official in Scotland in relation to the field of health and social care, that is to say within the Scottish Government?
Ms Caroline Lamb: I am.
Lead Inquiry: I believe that formerly you worked in the NHS in Scotland, you were the chief executive of NHS Education for Scotland, a post that you held from 2015, and then in 2019 you moved closer to the heart of the Scottish Government by leading the Digital Health and Care Directorate from December 2019.
From March 2020 you took on certain roles relating to the ICU surge requirements in the Scottish NHS, in relation to Covid, and you became the delivery director for the extended seasonal flu and Covid vaccination programme, and then you took up your present post, as you’ve said, in January 2021; is that correct?
Ms Caroline Lamb: Yeah.
Lead Inquiry: Now, given that you’re the first senior official in charge of the Scottish public health system to give evidence, I want to just take you through very briefly some of the structures in the organisations which play important roles in the Scottish public health system.
Public health is devolved, is it not, under the Scotland Act 1998?
Ms Caroline Lamb: That’s correct.
Lead Inquiry: Therefore it is something that is run from Scotland and, of course, not from Westminster?
Ms Caroline Lamb: No.
Lead Inquiry: There are in the Scottish Government, are there not, a variety of public health divisions?
Ms Caroline Lamb: Yes.
Lead Inquiry: Health protection, health improvement, drugs policy, Active Scotland and, since the pandemic, two or three further divisions; is that correct?
Ms Caroline Lamb: That’s correct, yes.
Lead Inquiry: All these divisions are based within the directorate of Population Health, and that directorate comes within your general purview of general health and social care?
Ms Caroline Lamb: Yes.
Lead Inquiry: All right.
Could we have, please, up on the screen the organogram INQ000204014, at page 6, which we will recall is the page relating to the structures within Scotland in 2019.
(Pause)
Lead Inquiry: There we are, thank you.
So just to familiarise ourselves, please, Ms Lamb, we can see there in the big yellow box in the middle the “Scottish Government”?
Ms Caroline Lamb: Yeah.
Lead Inquiry: We can see the “Scottish Government Resilience (Ministerial)” and the “(Officials)”, the two entities to which the previous witness referred.
Underneath the yellow box, the “Health and Social Care Directorates”. Is that the directorate with which you’re concerned?
Ms Caroline Lamb: That’s correct, yeah.
Lead Inquiry: We can see in there a number of entities: the Chief Medical Officer, Deputy Chief Medical Officer, Chief Nursing Officer and so on, to whom we’ll return shortly.
Could you just explain where, in the general field of things, that part of the Scottish Government concerned with emergency preparedness, resilience and response comes into it?
Ms Caroline Lamb: Yeah, the health –
Lead Inquiry: Is that a separate division within the Health and Social Care Directorates, or is it another directorate?
Ms Caroline Lamb: It sits within what’s currently known as the directorate of the Chief Operating Officer in NHS Scotland.
Lead Inquiry: Is the directorate of the Chief Operating Officer within the directorate of Health and Social Care?
Ms Caroline Lamb: It is, yes.
Lead Inquiry: So we would put that within the blue box in the middle.
Is that emergency preparedness, resilience and response division what was formerly called the “Health Resilience Unit”, and does that function, the emergency preparedness, resilience and response function, exist to work with and support the NHS health boards for which you are responsible because you are the chief executive?
Ms Caroline Lamb: That’s correct.
Lead Inquiry: All right. NHS Scotland has a number of parts to it, does it not?
Ms Caroline Lamb: It does, yes.
Lead Inquiry: I think there are a number of territorial health boards; is that correct? 14?
Ms Caroline Lamb: 14, yeah.
Lead Inquiry: Those health boards have responsibility for the population’s health and the delivery of frontline medical services and healthcare within their geographical boundaries; is that correct?
Ms Caroline Lamb: That’s correct, yeah.
Lead Inquiry: All right. Are there four NHS statutory bodies operating at national level in Scotland?
Ms Caroline Lamb: So there are actually eight bodies operating at a national level. You will see on the diagram seven of them are referred to as “Special Health Boards” and one is referred to as “Healthcare Improvement Scotland”. I believe that actually National Services Scotland, formerly the Common Services Agency, is also a corporate body rather than a special health board, so maybe this diagram needs a bit of tweaking.
Lead Inquiry: I think the tweaking is already under way, Ms Lamb.
Ms Caroline Lamb: Okay.
Lead Inquiry: The four major NHS statutory bodies, though – and we need to identify them because we’ll see them on the face of the papers – are: Public Health Scotland, NHS National Services Scotland, which we often see as NHS NSS, NHS Education for Scotland, and Healthcare Improvement Scotland; is that correct?
Ms Caroline Lamb: They are certainly the four bodies most relevant to public health in Scotland, yes.
Lead Inquiry: Yes, and there are four others which are perhaps a little less important for our purposes although no less important in the delivery of healthcare in Scotland: NHS 24, NHS Golden Jubilee and so on. All right.
Towards the bottom of the page you will see, at the bottom left, “Local Authorities” and “Emergency Planning Officers”.
There are 32 local authorities in Scotland. Do they play a pivotal role in the provision of healthcare or social care?
Ms Caroline Lamb: They play a pivotal role in the – having the responsibility for social care. They also play a role in relation to public health, so they have responsibilities in relation to communicable diseases and also environmental health.
Lead Inquiry: Is that because local authorities exist under statutory obligations in relation to communicable diseases?
Ms Caroline Lamb: That’s correct, yeah.
Lead Inquiry: I think under the Scotland Act or the public –
Ms Caroline Lamb: Public Health –
Lead Inquiry: Public Health Act 2008.
Ms Caroline Lamb: Yeah.
Lead Inquiry: Then the CMO, currently Ms Calderwood, is the CMO – at the top left-hand corner – of the Health and Social Care Directorates?
Ms Caroline Lamb: The CMO currently is Sir Gregor Smith.
Lead Inquiry: I apologise. We are due to hear from Ms Calderwood, I think Dr Gregor Smith’s predecessor?
Ms Caroline Lamb: That’s correct, yeah.
Lead Inquiry: The CMO is the most senior medical adviser to the Scottish Government and to NHS Scotland, of which you are the chief executive, and does the CMO therefore report to you, not because you are the chief executive of the NHS but because you are the director general for Health and Social Care?
Ms Caroline Lamb: That’s correct, yeah.
Lead Inquiry: All right. And there is a Deputy Chief Medical Officer as well, we can see, and a Chief Nursing Officer, one or two other bodies to which we’ve seen reference. Is there a body now called Public Health Scotland?
Ms Caroline Lamb: There is, yes.
Lead Inquiry: What was it formerly known as?
Ms Caroline Lamb: Public Health Scotland came into being on 1 April 2020. It brought together parts of organisations, so it was formed out of the health protection Scotland and information services division, which were previously part of National Services Scotland, and NHS Health Scotland, which was a separate organisation.
Lead Inquiry: All right.
On the subject of, while we’re still at the strategic level, if you like, in relation to health services and healthcare in Scotland, is there a body or a framework which exists to promote operational co-operation between the Scottish Government and national public health organisations in the rest of the United Kingdom, to which all the CMOs contribute?
Ms Caroline Lamb: Yeah.
Lead Inquiry: A common framework?
Ms Caroline Lamb: Yes, there is a common framework. There was – I think in the period prior to the pandemic, the Scottish Government had a memorandum of understanding with Public Health England, and that’s now been developed, since Public Health England no longer exists, into a common framework, yes.
Lead Inquiry: All right.
Do you have or have you ever had much by way of dealings with SAGE, the Scientific Advisory Group on Emergencies?
Ms Caroline Lamb: Not personally, however there is – the Scottish Government, Scottish Ministers are able to get advice from SAGE.
Lead Inquiry: Yes, and we can see them at the top of this page, can we not? There is no Scottish SAGE, is there?
Ms Caroline Lamb: That’s correct, there isn’t.
Lead Inquiry: So when SAGE, which isn’t a standing committee, convenes in London by the Government Chief Scientific Adviser and is chaired by the Government Chief Scientific Adviser or, in health emergencies, co-chaired with the English Chief Medical Officer, will members of the Scottish Government attend that committee if it is an emergency which concerns Scotland?
Ms Caroline Lamb: Yes.
Lead Inquiry: Is it therefore well known that, for the purposes of dealing with health emergencies, the Scottish Government may avail itself of advice both from SAGE, the Scientific Advisory Group for Emergencies, and also from NERVTAG, which is the committee on the top left of the screen?
Ms Caroline Lamb: Yes, that’s correct, yeah.
Lead Inquiry: Are you able to express any views as to whether or not that system works well, in your experience?
Ms Caroline Lamb: I don’t think I can express those views.
Lead Inquiry: All right.
There is also, as we’ve heard a few moments ago, a pandemic flu readiness board, which is towards the top of the page – thank you very much.
Ms Caroline Lamb: Yep.
Lead Inquiry: Very quick off the draw.
“Pandemic Flu Readiness Board and Programme”, and is that the Scottish pandemic flu readiness board and programme – I think it’s the Scottish one – set up following the order of the then Prime Minister and the National Security Council THRC committee in 2017?
Ms Caroline Lamb: I’m not sure which one that is. There were two, so there was the UK and the Scottish one, so I’m not sure what that one is.
Lead Inquiry: I think, because that is absent from pages 7 and 8 – we might just track this down.
Can we have page 7 and then 8.
If it’s missing from 7 and 8 then this will, on page 6, will the Scottish body.
It’s absent, so I think that is the Scottish one, which was put into place in 2017.
Ms Caroline Lamb: Right, okay.
Lead Inquiry: All right.
The 2011 strategy.
Ms Caroline Lamb: Yeah.
Lead Inquiry: The UK Pandemic Influenza Communications Strategy document. In your witness statement, you say this: that there was little requirement for advice being given by the Chief Medical Officer Directorate in Scotland in relation to pandemic flu planning because, primarily, it was considered that once the updated pandemic flu strategy had been agreed in 2011, there were, in reality, few decisions which required input from the CMO Directorate, and you express that view because, as Director General for Health and Social Care, you sit above the CMO; is that right?
Ms Caroline Lamb: Yes, that’s correct.
Lead Inquiry: So is this the position: that following the promulgation and the development of that strategy in 2011, that was the four nations strategy, if you like, that was set for everybody, and unless and until it was further revised or updated or changed, that was the strategy to which all four nations were committed?
Ms Caroline Lamb: Yes, that’s correct.
Lead Inquiry: Can you recall – or, from your enquiries and your research, can you recall that basic tenet, the agreement to the joint UK strategy, being challenged significantly at any time up to 2017 and 2018, when consideration was given to updating it and refreshing it?
Ms Caroline Lamb: No, I don’t recall.
Lead Inquiry: Do you know why there was no update or refresh, to use the jargon, of that strategy before 2018?
Ms Caroline Lamb: No, I don’t.
Lead Inquiry: Could we have a look, please, at that document, INQ000148759. Yes. I think actually this isn’t that document, this is a report on influenza preparedness, but it refers to the strategy. Do you recognise this document?
Ms Caroline Lamb: Yes, I do.
Lead Inquiry: Is it a July 2019 consultation draft prepared by the Scottish Government for your area in particular, but you weren’t in post then, Health and Social Care?
Ms Caroline Lamb: Yes, that’s right.
Lead Inquiry: It superseded an earlier document, but not in fact the 2011 UK strategy, and if we look at page 5 of this document, at the second bullet point, we’ll see – ah. Yes, thank you very much:
“The document highlights that pandemic planning is taking place at a UK level, with the four UK nations working together to update the UK Influenza Pandemic Preparedness Strategy … on which this guidance is based.”
So by July 2019, which is the date of the document on the screen, eight years later, the strategy that was in place, absent rewriting of the earlier document itself, was still based upon that approach from eight years before?
Ms Caroline Lamb: Yes, that’s correct. This document was produced – was the Scottish document that was produced to provide advice and guidance to our health and social care system at the time when the 2011 strategy was being updated but that work had not yet been completed.
Lead Inquiry: And –
Ms Caroline Lamb: At a UK level.
Lead Inquiry: Because the UK rewriting of which – and my Lady has heard plenty in terms of the witnesses who have spoken to it – because that rewriting had not taken place and, as we now know, never did take place because of Operation Yellowhammer, all the subsidiary documentation nationally, including this important document, was still based upon the old strategy, it was still based on the 2011 strategy?
Ms Caroline Lamb: That’s correct. However, we had obviously run our own exercises in Scotland.
Lead Inquiry: Yes.
Ms Caroline Lamb: Therefore we had sought to incorporate the lessons from those exercises into this guidance in order to try to ensure that our system was as prepared as it possibly could be.
Lead Inquiry: If we just look briefly, please, at page 6, paragraph 1.5, we can see there that the strategic objectives set out in that older document, 2011, are to:
“Be prepared to respond to any future influenza pandemic and any new emerging infections.
“Minimise the potential impact of a pandemic on society and the economy …”
And so on.
Page 7, 2.4, you’ve referred a moment ago by implication to the fact that the guidance in Scotland took its own path, even though it was based on the earlier UK strategy. 2.4:
“These strategies promote a culture within services that is person-centred, safe and effective, and which minimises health inequalities across the population.”
In summary and with half an eye on a number of policy documents which were prepared by the Scottish Government, was the issue of health inequalities flagged up in that Scottish guidance in a way that wasn’t in the 2011 strategy?
Ms Caroline Lamb: Yeah, this document draws on a number of other strategies in Scotland which are highlighted at the paragraph above, 2.3, and in amongst that is the recognition of the importance of addressing health inequalities. So in amongst those – in amongst those strategies.
So when I think about the health and social care delivery plan, that’s the document in which we confirmed the intention to establish Public Health Scotland and to have, at the core of that organisation, a mission to tackle health inequalities.
Lead Inquiry: There are actually many, many references to the –
Ms Caroline Lamb: Absolutely.
Lead Inquiry: – Scottish Government’s desire to tackle health inequalities in the rubric of civil contingencies documentation and public health documentation.
Ms Caroline Lamb: That’s correct, yeah.
Lead Inquiry: In a way which, I’m sure you’re aware, isn’t apparent from the English or UK analogues.
Page 10, paragraph 3.6, on the issue of how a pandemic would be responded to, this July 2019 draft guidance says:
“The initial response to the pandemic will be followed by the Treatment phase, as it will not be possible to curtail the spread of the pandemic strain of influenza once it has occurred in Scotland.”
Is that a reflection of the same doctrinal or strategic issue with which I’m sure you’re very familiar, which is that the 2011 strategy presumed that little could be done to prevent spread and, therefore, it focused upon the management of the catastrophic consequences as opposed to preventing their creation, their arrival?
Ms Caroline Lamb: So that’s correct, the 2011 strategy and indeed I think probably all our approaches to strategies to deal with pandemic influenza made the assumption that it would not be possible to contain the spread and, therefore, the focus was on mitigating the impact of the disease.
That is slightly different from an approach to other emerging and communicable diseases where there was an assumption that it might be possible to contain that.
Lead Inquiry: Yes. I think I would press you on the use of the word “slightly different”, obviously the consequences of that divergence were massive.
Ms Caroline Lamb: Yeah.
Lead Inquiry: Page 16, there is a reference to something called “Integration Authorities”.
Ms Caroline Lamb: Yeah.
Lead Inquiry: Could you just assist with what they are? There is a reference to “Health and Social Care Partnerships” in paragraph 5.5, and then further down the page “Integration Authorities”. What are they?
Ms Caroline Lamb: Yeah, so on the – on the sort of organogram that you referred me to earlier, where you – between local authorities and health boards, if I’m remembering this correctly, sit –
Lead Inquiry: If you just pause there, we’ll get INQ000204014 back, if we may, and then you’ll be able to see it clearly in front of you.
Ms Caroline Lamb: Okay, thank you.
(Pause)
Lead Inquiry: It was page 6.
(Pause)
Lead Inquiry: I think our system is slowing down, electronically.
There we are, Ms Lamb.
Ms Caroline Lamb: Okay, so down at the bottom you’ve got, around about the middle, “NHS Scotland … Territorial Boards”, 14 of them, and to the left of that “Integrated Joint Boards” and “Health and Social Care Partnerships”, and to the left of that “Local Authorities”. And that reflects the legislation that brought together integrated joint boards. They are organisations that are responsible for planning and funding services, both community health services and social care services. So social care services that are the responsibility of and were previously delivered by – entirely by local authorities, and some community care services from NHS boards as well. So the principle of that legislation was to enable a sort of more seamless service for people regardless of which organisation was actually – had the statutory responsibility for their care. So that’s where those integrating bodies sit.
Lead Inquiry: Could I be permitted to try to simplify it yet further, if you’ll forgive me. The Act I think in 2004 obliged health and social care staff from local authorities to work with NHS health boards to provide a more seamless service?
Ms Caroline Lamb: That’s correct, yeah, it’s 2014.
Lead Inquiry: What is the difference between integrated joint boards, then, and health and social care partnerships? Or are they the same?
Ms Caroline Lamb: So the integrated joint board is the legal structure, the health and social care partnerships are really the operational mechanisms by which they enact those responsibilities and bring staff together into teams.
Lead Inquiry: All right.
That July 2019 document to which you were referring, but we needn’t go back to, refers to two other bodies which are important to be identified, because of the role they play in the field of public health provision in the event of a health emergency.
Firstly, on the far right-hand side of the page the “Scottish Government Resilience Room (SGoRR)”, is that, if you like, the Scottish crisis management –
Ms Caroline Lamb: It is.
Lead Inquiry: – facility?
Then towards the left-hand side of the page, we have “Regional Resilience Partnerships” and, below them, “Local Resilience Partnerships”. Are those the organisations at local level, under the principle of subsidiarity, which bear the burden of both planning and then responding at a local level because all emergencies have local impact?
Ms Caroline Lamb: That’s correct, yeah.
Mr Keith: All right.
My Lady, if that’s a convenient moment?
Lady Hallett: Certainly.
I hope you were warned you may go over lunch.
The Witness: Yes, that’s fine.
Lady Hallett: Thank you very much. I shall return at 1.45.
(12.45 pm)
(The short adjournment)
(1.45 pm)
Lady Hallett: Mr Keith.
Mr Keith: Ms Lamb, before lunch we were looking at INQ000148759, the draft influenza pandemic preparedness document.
Could we have, please, page 29, paragraph 10.2.
Obviously in relation to countermeasures, on account of the strategic nature of the document, which we debated earlier, the only infection control procedures that were identified and debated in the course of this draft document could be those that were related to influenza: hygiene, respiratory and cough hygiene, patient placement, personal protective equipment, safe management of the care environment.
Then if you scroll back out and just scroll slowly down to 10.7: respiratory protective equipment, FFP3 respirators, stockpiles of personal protective equipment.
So obviously it followed, did it not, Ms Lamb, from that strategic approach adopted in the 2011 strategy and then in the draft July 2019 document that the only countermeasures that were really considered were those applicable for flu and, of course, not necessarily for a catastrophic HCID?
Ms Caroline Lamb: That’s correct, this is a plan for a pandemic influenza.
Lead Inquiry: The risk assessment process, is that something which you have an involvement in as the Director General for Health and Social Care?
Ms Caroline Lamb: No, so the risk assessment process obviously we have the Scottish Risk Assessment –
Lead Inquiry: Indeed.
Ms Caroline Lamb: – but that is largely informed by the National Risk Assessment, and what the Scottish Risk Assessment seeks to do is to sort of apply any specific issues that relate to impacts in Scotland.
Lead Inquiry: The same assumptions are made – the same approach, generically, to planning assumptions are made, it basically mirrors with a national bent in terms of the figures, population, casualties and fatalities, the UK approach?
Ms Caroline Lamb: That’s correct.
Lead Inquiry: All right.
Response policy documents. Much of your statement helpfully sets out many of the documents published by the Scottish Government for the purposes of responding to an influenza pandemic: Pandemic Flu Guidance; Preparing For Emergencies; Guidance for Health Boards; the Preparing Scotland document; Scottish guidance on resilience; Preparing Scotland, guidance for Scotland’s regional resilience partnerships; and so on.
I don’t think we need to address any of them in detail, but is it fair to say that both across the civil contingencies field and public health, there have been a significant number of documents published more recently than latterly, so that is to say there were a whole series of documents between 2013 through 2015, 2016, 2017 and then up to that draft that we’ve just been looking at?
Ms Caroline Lamb: Yeah, that’s correct.
Lead Inquiry: All right.
An important separate area on which the Scottish Government reported was inequalities. Did the Auditor General for Scotland produce a seminal report on health inequalities in Scotland in 2012?
Ms Caroline Lamb: That’s correct, yes.
Lead Inquiry: May we have that up, please, INQ000102987. “Health inequalities in Scotland”.
Given that this was dated December 2012, was this regarded as being quite prescient? Were there other comparable documents dealing with health inequalities in the United Kingdom published by any of the devolved administrations?
Ms Caroline Lamb: There were other comparable documents published in Scotland, yes. So in, I think it was, 2008, there was a report called Equally Well, which was the ministerial taskforce on health inequalities in Scotland. That was then reviewed I think in 2010, and then again –
Lead Inquiry: 2013 as well?
Ms Caroline Lamb: – 2013, yeah.
Lead Inquiry: So essentially there were – a taskforce or a generic approach applied, adopted by the government in Scotland, Equally Well. The Auditor General for Scotland then sought the views of community planning and health professionals in order to further the issue and the debate revolving around health inequalities in Scotland.
Then – and this will be familiar to you – did NHS Health Scotland then carry out its own health inequalities policy review in 2013?
Ms Caroline Lamb: It did. I believe that that was to inform the review of the ministerial taskforce as well. So, again, it all linked back to the original document, Equally Well.
Lead Inquiry: Then were there four or five even wider reviews of public health in Scotland, all of which made reference to health inequalities: Review of Public Health in Scotland in 2015; Health and social care delivery plan, December 2016; Public health reform programme, 2017; July 2018, Public Health Priorities?
Ms Caroline Lamb: Yeah, so to link those together, the ministerial review of Equally Well, which took place in 2013, I think had some concerns about the extent to which we were making progress in tackling health inequalities, and that was the genesis of the setting up the public health review group, who subsequently reported in 2014.
The question that was set to that group was: how can we be more effective at tackling health inequalities? That review group then reported, and amongst their recommendations was to look at how we bring together the organisations with an approach towards public health and that then was the commission to start to look at setting up what became Public Health Scotland.
Lead Inquiry: In your view, has this proliferation of policy and reviews and documents over now quite a considerable amount of time worked?
Ms Caroline Lamb: I think it’s hard to say that it has worked because we have not seen the reduction that we would want to see in health inequalities in Scotland, and that has been impacted by the pandemic as well as other economic and socio-economic factors.
I think what it has done is, in bringing together NHS Health Scotland, the Health Protection Scotland, previously as part of National Services Scotland, and Information Services Division, who were again part of National Services Scotland, bringing them all together, what that has done is it has established a single national oversight of public health. It is a health board, it’s established as a health board, and accountable to Scottish Ministers, but it’s also jointly sponsored by COSLA, the Convention of Scottish Local Authorities, so it’s got – it’s, if you like, jointly owned by ministers and by local government, and I think that enables us to really have health inequalities at the heart of everything we do, which is also key to other policies across Scottish Government as well.
Lead Inquiry: Is the point that in this particular regard, because this is a joint enterprise between COSLA, the Convention of Scottish Local Authorities, and the Scottish Government, the whole approach to inequalities and the need to address them becomes more embedded into the system?
Ms Caroline Lamb: Yeah.
Lead Inquiry: All right.
Ms Caroline Lamb: Absolutely, and it’s about it being beyond health, so it’s not just about – health and social care systems can only tackle a small proportion of health inequalities. Most health inequalities are driven by economic factors, environmental factors, socio-economic factors, particularly poverty.
Lead Inquiry: I suppose you would say a whole-society approach is required?
Ms Caroline Lamb: Absolutely.
Lead Inquiry: What about in the field of civil contingencies? So with this broad generic whole society approach, is it your view that planners and responders in the field of civil contingencies, and in particular health emergencies, are they equally alert to the need to ensure that plans and responses take into account the needs and the vulnerabilities of those suffering from inequalities?
Ms Caroline Lamb: I would say that I think there’s still work to be done there, so Public Health Scotland was established really after the pandemic struck, so whilst a lot of preparatory work had been done to get us to that stage, probably some of those ideas and ways of thinking were not fully embedded.
I think as well that – you know, I think we would all say that we could have thought more about health inequalities in our planning for emergencies, although, as you’ve already pointed out, the 2019 draft guidance did specifically reference the need to be – to focus on health inequalities in developing those local plans.
Lead Inquiry: But of course it remained in draft form –
Ms Caroline Lamb: It did, yes.
Lead Inquiry: – because of the pandemic.
On the question of funding for pandemic preparedness, is the funding for high-consequence infectious disease planning and response contained within a general consolidated fund or does it come out of the NHS board budgets for which you are in part responsible?
Ms Caroline Lamb: So I guess there’s two aspects to that. So, yes, we provide baseline funding to all NHS boards. Over and above that, since – well, throughout the whole period that this Inquiry has covered, we have provided additional funding for board resilience, including prepared – being prepared for pandemics.
Lead Inquiry: So the budget is controlled by and is run by the NHS boards, which of course receive money from the Scottish Government, and that presumably forms a majority part of the Scottish Government’s expenditure –
Ms Caroline Lamb: It does, yes.
Lead Inquiry: – being a devolved issue?
Ms Caroline Lamb: Yeah.
Lead Inquiry: Does the system work well with high-consequence infectious disease budget, in terms of planning and preparedness and response, being managed and operated through NHS Scotland as opposed to centrally from the Scottish Government?
Ms Caroline Lamb: I think it’s hard to say whether that works well or not. Certainly when we – as we went into Covid the funding was managed much more – the funding was increased very substantially in order to put in place the infrastructure that we needed to support things such as contact tracing, testing. That was managed at the point it was felt most appropriate. So some of that was allocated to NHS boards in order to run their local systems, but we also had a national capacity on top of that, and the funding for that was managed by Scottish Government.
Lead Inquiry: All right. But that, of course, was in the particular context of responding to Covid.
Ms Caroline Lamb: Yeah.
Lead Inquiry: But as a system, does the majority of the funding for health emergency planning and response come through the NHS –
Ms Caroline Lamb: It does.
Lead Inquiry: – Scotland structure?
Ms Caroline Lamb: Yeah.
Lead Inquiry: All right.
Exercises, national preparedness and resilience exercises. You will no doubt be familiar, and you may have seen the evidence from the witness who gave evidence prior to you, is it clear that, whilst the majority of the recommendations which flowed from Exercise Cygnus – although Scotland was of course only partially involved in that exercise – Silver Swan and Iris were put into place and implemented, not all of the actions, lessons and recommendations were, for reasons that are now becoming very apparent?
Ms Caroline Lamb: Yes, that’s correct.
Lead Inquiry: To what extent, although you weren’t in post at the time, was your department aware that, notwithstanding the passage of time, and a considerable amount of time, these recommendations were just not being implemented in full?
Ms Caroline Lamb: Given that I wasn’t in post at the time, I’m not sure I can answer that one.
Lead Inquiry: No, but it’s an issue which you address in your witness statement, so you must have given it some thought for the purposes of your attendance today.
Ms Caroline Lamb: So I think we were conscious that – we knew that not all the recommendations had been addressed, so we knew that one of the recommendations outstanding was the 200 –
Lead Inquiry: The refresh of the –
Ms Caroline Lamb: – the refresh of the plan, and we knew that that was in draft, we knew it was ready to go out for consultation. It had taken longer than we had originally expected, and that’s because we had consulted originally with quite a small group, and that had led to some changes to that.
I think the other area that we were concerned about in terms of things not being maybe fully implemented was around the criteria for staff getting access to different types of PPE and the awareness of the PPE stockpile. That was also addressed within that guidance. So that hadn’t been fully signed off either.
Lead Inquiry: Just so that we’re clear about that, one of the recommendations, I think from Iris, was that there needed to be a better understanding of potential use of respiratory protective equipment, the need for a survey of NHS boards and local authorities to understand what their needs might be, and that process of trying to identify what their prospective needs might be was never finally concluded?
Ms Caroline Lamb: We had extended the survey, so we had been carrying out a survey of NHS boards in relation to their respiratory PPE, since I think 2015, and we had updated that survey to include additional questions about the number of staff who were fit tested for FFP3 masks, so we had implemented that, I don’t think we’d yet had time to fully act on all the information that came out of that.
We’d also written to NHS boards in July 2019 to remind them of their responsibility to make sure that staff who would require FFP3 masks were fit tested for those and that they had sufficient of those. That was in response to, I think, an Ebola outbreak.
Lead Inquiry: Could you just explain something about what sorts of masks those are? You say FFP3 masks.
Ms Caroline Lamb: Yeah.
Lead Inquiry: Is that a particular grade of mask which is required in certain HCID scenarios?
Ms Caroline Lamb: Yes, that’s the case. That’s a grade of mask that protects people who are involved in procedures that might create aerosol.
Lead Inquiry: So the position then in relation to PPE and masks is that work was done in relation to raising awareness of the need for the stockpiles of PPE and masks to be up to date, letters were written to the health boards to say “Are you ready”?
Ms Caroline Lamb: Yeah.
Lead Inquiry: But some of the test, particularly fit testing around PPE, wasn’t concluded by the time that the pandemic struck?
Ms Caroline Lamb: Yes, there was variability between the extent to which NHS boards had completed the fit testing.
Lead Inquiry: The other main area where work wasn’t completed was in relation to the production of guidance for those entities, local authorities, dealing with health and social care, but also of course your department, because your department has a greater involvement in –
Ms Caroline Lamb: Yes.
Lead Inquiry: – adult social care than its analogous department in London?
Ms Caroline Lamb: Yes, that’s correct, although since 2000 – in 2016 we issued standards for organisational resilience for NHS boards, and in amongst those standards was a requirement for plans to be developed in partnership with regional resilience partnerships and health and social care partnerships. So although that 2019 formal guidance hadn’t actually formally been issued, there was already an assumption within those standards for NHS boards that they would be working together with partners to develop multi-agency plans.
Lead Inquiry: But the guidance –
Ms Caroline Lamb: But the guidance hadn’t formally issued.
Lead Inquiry: The process of drawing up the guidance hadn’t been finished and so you weren’t able to conclude that process by which those persons or entities responsible for adult social care knew where they stood definitively in relation to the provision of care in the event of a pandemic?
Ms Caroline Lamb: We had, by producing the NHS board standards for organisational resilience in 2016. And then I think updating them in 2018, what we had done was to set out the standards that we expected boards to self-assess themselves against, and that did include working with their partners who were responsible for the provision of social care in producing those joint multi-agency plans. But you’re correct that we hadn’t formally issued the guidance as to how to do that.
Lead Inquiry: Finally, following the pandemic, there was, in Scotland, a report from the Auditor General drawn up and published entitled NHS in Scotland 2020; is that correct?
Ms Caroline Lamb: That’s correct, yeah.
Lead Inquiry: Thank you very much. Did that state on page 4 that:
“The Scottish Government could have been better prepared to respond to the … pandemic. It based its initial response on the 2011 UK Influenza Pandemic Preparedness Strategy [is that the strategy that we’ve been debating?] but did not fully implement improvements identified during subsequent pandemic preparedness exercises.”
Are those the failures, such as they were, that we’ve also been debating?
“It also did not include an influenza pandemic as a standalone risk in its corporate or health and social care directorate [your directorate] risk registers, despite assessing it as high risk.”
Did the absence of, some might say, a formulaic reference to influenza pandemic in the department’s high level risk register matter ultimately?
Ms Caroline Lamb: I think it’s clear that we were already involved in a lot of work to improve our preparedness. I think the issue here is that maybe our risk management processes didn’t adequately reflect the activity that we had under way, and it really should be the other way round, that our risk management assessment should influence our activity.
Lead Inquiry: The Auditor General’s report made reference to a number of ways in which the recommendations from Silver Swan, Iris and Cygnus hadn’t been fully implemented and suggested that the Scottish Government should update and publish national pandemic guidance for health and social care.
Ms Caroline Lamb: Yeah.
Lead Inquiry: Has that been done?
Ms Caroline Lamb: No, that’s not been done yet. We are reviewing – that 2019 guidance is being reviewed in the light of experiences from Covid, from the initial wave, but also subsequent waves of Covid that we’ve been through.
Lead Inquiry: That report from the Auditor General was dated February 2021.
Ms Caroline Lamb: Yeah.
Lead Inquiry: We now are, I’m told, in June 2023. That’s a considerable elapse of time. Why has that guidance not been brought together?
Ms Caroline Lamb: I think that’s a reflection of the fact that the system has been through successive waves of Covid and also intense pressures.
Lead Inquiry: Has the Scottish Government nevertheless established a Standing Committee on Pandemic Preparedness?
Ms Caroline Lamb: That’s correct, yes.
Lead Inquiry: As it suggests, it’s a standing committee. Is that now a committee that is continuing to meet to address all aspects of pandemic preparedness?
Ms Caroline Lamb: Yes, that’s the intention of that committee.
Lead Inquiry: Not just influenza but other catastrophic HCIDs?
Ms Caroline Lamb: That’s correct.
Lead Inquiry: Is that a committee that reports to part of the Scottish Government or is it an external committee?
Ms Caroline Lamb: It’s – it has an external chair but it reports to ministers.
Lead Inquiry: Are there scientists and technical experts who contribute to the committee along with the Chief Medical Officer?
Ms Caroline Lamb: Yes.
Mr Keith: Thank you very much.
My Lady, those are all the questions that I have for Ms Lamb. There are no areas which I don’t – appear to have not covered.
Lady Hallett: Thank you, Mr Keith.
Thank you very much indeed, Ms Lamb, I’m very grateful for your help.
The Witness: Thank you very much.
(The witness withdrew)
Ms Blackwell: My Lady, the next witness, Jeane Tennent Freeman OBE is appearing over the link.
Lady Hallett: Thank you.
Ms Jeane Freeman
MS JEANE TENNENT FREEMAN (called).
(Evidence via videolink)
Lady Hallett: I can see the witness.
Ms Blackwell: Thank you. Would you give your full name to the Inquiry, please.
The Witness: It’s Jeane Tennent Freeman .
Ms Blackwell: Thank you, and would you please take the oath or affirmation.
The Witness: Perhaps if you could speak a little louder?
Ms Blackwell: Can you hear me now clearly?
The Witness: I can, yes.
(Witness partly affirmed)
Ms Blackwell: I’m sorry, my Lady, the screen seems to have frozen.
Lady Hallett: A lot of time was spent over lunch trying to solve this, but …
Ms Blackwell: Yes. I’m just going to pause and see if our technical experts are able to solve the problem.
Lady Hallett: It’s just the last line of the affirmation to go, isn’t it?
(Pause)
Lady Hallett: I won’t leave, let’s just see how we go.
Ms Blackwell: Thank you, my Lady.
(Pause)
Lady Hallett: Do we know if she is coming from her home, an office, a government building?
Ms Blackwell: I’m unsure, my Lady, I don’t know where she is.
(Pause)
Ms Blackwell: My Lady, it doesn’t look like it’s necessarily going to be a quick fix.
Lady Hallett: I think it’s quicker if I stay here just in case.
Ms Blackwell: All right.
(Pause)
Lady Hallett: It’s not your fault, these things happen. Very well, tell me when you’re ready.
Ms Blackwell: I will.
Lady Hallett: Thank you.
(2.11 pm)
(A short break)
(2.16 pm)
Ms Blackwell: My Lady, I’m told that we are re-established and ready to go again.
Lady Hallett: Could we start the affirmation again, if you don’t mind, Ms Freeman.
The Witness: Not at all.
(Witness affirmed)
Questions From Counsel to the Inquiry
Ms Blackwell: Ms Freeman, can you hear and see me?
Ms Jeane Freeman: I can.
Counsel Inquiry: Great, thank you.
During the course of –
Ms Jeane Freeman: My apologies, I wonder if before we begin I could make two points, if I may?
Counsel Inquiry: Yes, please.
Ms Jeane Freeman: The first, as the first appearance of a Scottish Government minister to this hearing, I want to express my sincere condolences to everyone who has been affected by the Covid pandemic, both at the time and I know many still are.
I also want to thank our health and social care staff in Scotland in particular for their professionalism, their dedication, and their sheer hard work, which made such a difference to us working our way through the pandemic.
My second point, Lady Hallett, if I may, is to thank you for allowing me to give my evidence in this way on this occasion, notwithstanding our IT glitches. I very much appreciate your forbearance in that.
Lady Hallett: Not at all. Thank you.
Ms Blackwell: Thank you, Ms Freeman.
You have provided a witness statement. If we can have it on screen, please, it’s at INQ000182604. That’s the first page, and the final page is page 6. Thank you. We can see that there you have signed it on 19 April of 2023.
Can you confirm, please, Ms Freeman, that that is true to the best of your knowledge and belief?
Ms Jeane Freeman: It is.
Ms Blackwell: Thank you.
May we have permission to publish it, my Lady?
Lady Hallett: Certainly.
Ms Blackwell: Thank you, we can take that down.
If during the course of your evidence, Ms Freeman, the link becomes difficult or you can’t hear or see me, please let us know, and equally if you need a break at any time you will let us know as well.
Ms Jeane Freeman: Thank you.
Counsel Inquiry: In terms of your background relevant to this Inquiry, you were a Member of the Scottish Parliament between 2016 and 2021; you were Minister for Social Security from May 2016 to June 2018, you were Cabinet Secretary for Health and Sport from June 2018 until May 2021; and you are currently an ambassador for community engagement public health and innovation for the College of Medical, Veterinary and Life Sciences at the University of Glasgow.
Is that right?
Ms Jeane Freeman: It is correct up until the last part. My title now at the University of Glasgow is Dean of Strategic Communication and Economic Development.
Counsel Inquiry: Thank you.
In terms of your experience of health in Scotland, as we have established, you were Cabinet Secretary for Health and Sport during the time that the Covid pandemic hit, and at paragraph 8 in your witness statement you tell us that:
“… one of the key lessons to be learned is to be more fully [integrating] and [resourceful of] … public health policies and delivery, both in terms of the overall delivery of health and social care in Scotland, and in the need to effectively tackle health inequalities, and in the resilience and emergency response structures at national, regional and local levels.”
So your principal lessons from the pandemic and the run-up to the pandemic are to integrate and resource public health and social care, address inequalities, and – is this right – to improve the EPRR structures?
Ms Jeane Freeman: Yes, I think that is correct. I think the pandemic (connection lost) criticality of the public health infrastructure, and became clear to me that we needed to do more to resource that structure.
Counsel Inquiry: From the time that you became Cabinet Secretary for Health and Sport, did any of those three issues and the need to improve them occur to you, or was it only from the Covid pandemic hitting that it became apparent to you that there needed to be improvements in those three areas?
Ms Jeane Freeman: I think it would be true to say that I have long-standing concern about health inequalities, prior to being the Cabinet Secretary, in previous roles. So I was very aware of the importance of being able to effectively tackle those across Scotland, and of the many initiatives that my – the government I was part of and previous governments had undertaken. But we were still faced with an intractable problem. Of course health inequalities are directly linked to economic inequalities, so it’s not an issue solely for health to try to resolve, but there is a critical importance there of what health might do.
Counsel Inquiry: When you came into office, were you aware of the United Kingdom influenza preparedness strategy that had been implemented in 2011?
Ms Jeane Freeman: I was.
Counsel Inquiry: Although it was before your time in office, were you aware that in fact before the swine flu outbreak in 2009 Scotland had had its own pandemic influenza strategy?
Ms Jeane Freeman: Yes.
Counsel Inquiry: Do you think that there were any drawbacks in Scotland aligning itself entirely with the United Kingdom wide strategy, given that it was, as we now know, implemented in 2011 and not updated over the following nine years and before the pandemic hit?
Ms Jeane Freeman: I think that would be fair, a fair assessment, if that had been the only thing that was informing our pandemic preparedness. But of course it wasn’t. It had been a number of exercises you and your colleague have covered with previous witnesses, there was the emergence and publication of the Scottish Risk Assessment, and various updated guidance as a consequence of some of those exercises, all of which came together to update and inform pandemic preparedness, but also resilience and preparedness across a range of other issues that might affect the country and the people who live here.
Counsel Inquiry: Well, in relation to the Scottish Risk Assessment, as we’ve established at the Inquiry this morning, although the Scottish Risk Assessment dealt with the population numbers relating to Scotland itself, there was very little additional alteration to the National Risk Assessment which was prepared nationally and for national guidance and in relation to which there was no additional Scottish input other than the population figures; do you agree with that?
Ms Jeane Freeman: By national, I assume you’re meaning UK?
Counsel Inquiry: Yes.
Ms Jeane Freeman: Yes. So whether or not the UK takes account, or the United Kingdom Government takes account of the Scottish Risk Assessment, which was published in 2018, is really for them to answer. What I do know is that it was a wide risk assessment, it gave a clear indication in terms of health issues along with others of an estimate of likelihood and impact and that would inform how the Scottish Government prepared itself for any future incidents which represented a threat to the proportion.
Counsel Inquiry: In relation to the UK-wide influenza preparedness strategy, was there ever any discussion during your time in office in Scottish Government that there should be an adaptation of that in order to make it more Scottish-centric?
Ms Jeane Freeman: Not that I’m aware of. What I do know is that the various exercises that have been touched on during the hearing so far did inform the work of what became Public Health Scotland but also the health directorate, and some of the guidance that was issued to regional and local – particularly regional – resilience partnerships.
Counsel Inquiry: Well, you tell us at paragraph 17 in your witness statement that your understanding is that the lessons which came from the exercises fed into your pandemic planning and preparedness. Can you tell us how the lessons fed into your pandemic planning and preparedness, please.
Ms Jeane Freeman: Yeah, if I could give you some examples of that. So one of those areas would be the –
(Connection lost)
Ms Blackwell: Oh dear. We were doing so well.
Lady Hallett: I think I’m going to stay put this time.
Ms Blackwell: Yes.
Lady Hallett: Stay positive.
(Pause)
Ms Blackwell: I’m being told, my Lady, that they’re going through the same process that they did last time, so it may take about five minutes, but …
Lady Hallett: I’m staying.
Ms Blackwell: I’ll stay too.
(Pause)
Ms Blackwell: Ms Freeman, hello, can you see and hear me again?
Ms Jeane Freeman: I can, thank you very much.
Counsel Inquiry: Thank you.
We were discussing how the lessons learned from the exercises fed into your pandemic planning and preparedness, and I was asking you for details of how that took place.
Ms Jeane Freeman: Yeah, so if I could give you a couple of examples of that, one of which would be the NHS Scotland standards for organisational resilience published in 2016. There was guidance issued to our health boards on the back of the lessons learned from those exercises. Of course, Operation Cygnus or Exercise Cygnus was not specifically focused on the Scottish situation, but we did take their recommendations into account. And in terms of Iris, there were a number of specific actions that fed through from Iris, including the respiratory protective equipment survey which has been carried out consistently since 2015, and – I think as Ms Lamb indicated – the letter issued to health boards in 2019 asking them to ensure that their plans were updated with respect to the recommendations that had come out of the various exercises; and of course Health Protection Scotland which was a precursor to Public Health Scotland, did update its guidance on both SARS and MERS.
Counsel Inquiry: In addition to which there were several recommendations from the three exercises, Silver Swan, Cygnus and Iris, which by the time the Covid pandemic arrived had not been implemented, had they?
Ms Jeane Freeman: That’s correct.
Counsel Inquiry: So although you don’t cover this in any detail in your witness statement, I’m taking what I’m going to put to you now from the witness statement of the former First Minister, Nicola Sturgeon.
In relation to Exercise Silver Swan, still outstanding at the outbreak of Covid was an update to the pandemic guidance for the health and social care aspect of government, and she tells us in her witness statement that officials took the decision not to publish the guidance when the consultation had concluded in 2019, because that may have led to confusion in directing the Covid response.
Do you agree with that?
Ms Jeane Freeman: Yes, that’s correct.
Counsel Inquiry: Secondly, that there was a recommendation to continue the process of integrating health and social care partnerships into local pandemic planning, but that had not been successfully implemented at the time that Covid hit, had it?
Ms Jeane Freeman: It hadn’t, although they were part of local resilience partnerships.
Counsel Inquiry: Third, there was a recommendation to raise awareness of national PPE stockpiles and distribution, and that had not been successfully implemented, had it, by the time that Covid hit?
Ms Jeane Freeman: No, it hadn’t.
Counsel Inquiry: And, finally, getting more staff at NHS boards fit tested on PPE, which is an issue that Caroline Lamb helped us in relation to earlier today, and again although that was in the process of being organised, in fact that hadn’t been carried out, had it?
Ms Jeane Freeman: It hadn’t been completed, no.
Counsel Inquiry: No.
In relation to Exercise Cygnus, whilst you say that Scotland wasn’t an active participant in that exercise, nevertheless there were eight recommendations which covered the updating of pandemic guidance, operational aspects of co-ordinating a response, and also the expansion or optimisation of social care capacity, so similar themes to those that had been covered in Silver Swan.
Again, according to paragraph 21 of Ms Sturgeon’s statement, those matters had not all been implemented by the time that Covid hit. Do you agree with that?
Ms Jeane Freeman: I do.
Counsel Inquiry: May we display, please, INQ000103013, which is the report into Exercise Cygnus. This was, as we know, a tabletop exercise conducted in Scotland in March of 2018, and if we can go to page 14, please, second paragraph:
“The exercise identified 14 actions across a broad range of themes. Despite the breadth of discussion, there were no great surprises in the issues identified as priorities. In the event of a large scale crisis, Boards will appreciate strong, national co-ordination and clear guidance. Scottish Government and Health Protection Scotland should endeavour to ensure that relevant guidance is up to date and communicated effectively and that processes are in place for standing up and accessing national co-ordination structures and that these processes are widely agreed and understood. Amongst frontline staff there is unease at the lack of clarity on PPE availability, training and testing. This is a clear gap in Scotland’s preparedness for MERS CoV and other outbreaks and needs to be addressed as soon as possible.”
So this was in March of 2018. If we go over to the following page, please, we can see a series of 13 actions that were identified in Exercise Iris, and outstanding when Covid-19 struck were the following: Updating guidance on MERS CoV and incorporating various operational points in relation to care pathways and management of infected staff, NHS boards building in the potential impact of contact tracing and community sampling, and also continuing existing work to promote standard PPE requirements and the specific requirements of a high-consequence infectious disease.
Ms Freeman, can you still see and hear me?
Ms Jeane Freeman: I can still see and hear you. It dropped off for a minute, but I can see and hear you now.
Counsel Inquiry: So looking at the actions that were still outstanding from the three exercises at the time that Covid hit, and indeed at the time that you provided your witness statement in April of this year, do you still say that some of the lessons that were identified had been fed into your pandemic planning and preparedness, but would it be right to say that some of the lessons were yet to be fully actioned and completed?
Ms Jeane Freeman: Yes, I’d agree that that’s fair.
Counsel Inquiry: All right. Thank you. We can take that down, please.
I now want to look briefly, please, at three reports.
I think, my Lady, that these have already been referenced today, but I can deal with them shortly, I hope.
The first is the 2020 Audit Scotland report NHS in Scotland and it’s at INQ000148761. Thank you.
This is the one exhibit to your witness statement, Ms Freeman, and I’m going to read through some of the actions, please, that we see at page 20 to 21. Thank you.
“Not all actions from previous pandemic preparedness exercises were fully implemented”, as we’ve just established.
“The Scottish Government based its initial response to Covid-19 on the 2011 UK Influenza Pandemic Preparedness Strategy.
“41. In its consideration and assessments of risks to Scotland, the Scottish Government rated the risk of an influenza pandemic as highly likely to occur with a potentially severe impact. This aligns with the risk classification of an influenza pandemic in the UK National Risk Register of Civil Emergencies, 2017. However, the Scottish Government did not include an influenza pandemic as a standalone risk in its corporate or health and social care risk registers. This meant that there was not adequate corporate oversight of this risk, and it is therefore unclear how it was being managed and monitored.”
Ms Freeman, were you aware in the run-up to the pandemic that an influenza pandemic as a standalone risk had not been set out in the corporate or health and social care risk registers?
Ms Jeane Freeman: No, I wasn’t.
Counsel Inquiry: Do you agree that that meant that there was not adequate corporate oversight of that risk?
Ms Jeane Freeman: It may be the case that there was inadequate corporate oversight, but I do believe there was adequate health oversight of the risk.
Counsel Inquiry: “42. The Covid-19 pandemic was caused by a new virus with unknown characteristics. Initially there was insufficient evidence internationally to show how the virus behaved and was transmitted, who was at risk and what the incubation period was. The Scottish Government had no plan in place to manage this specific kind of outbreak so its response was informed by [the strategy that we’ve just referred to]. This was developed jointly by the four governments of the UK. The Scottish Government’s response was also informed by the 2017 Management of Public Health Incidents: Guidance on the Roles and Responsibilities of Incident Management Teams. The Scottish Government’s response to Covid-19 had to be adapted frequently as new information emerged.”
Then the audit report goes on to deal with the exercises that we’ve just covered, so we can skip over that, and on to the next page, please.
Here we see that the audit also covers the progress in addressing recommendations from pandemic preparedness exercises as being slow. Would you agree with that?
(Connection lost)
Lady Hallett: Frozen screen.
Ms Blackwell: Yes.
(Pause)
Ms Blackwell: I’m being asked how much longer I’ve got. I think I can wrap things up in about five minutes.
Lady Hallett: And I think I’ve given provisional permission to Ms Mitchell.
Ms Blackwell: I think so, yes.
Is it one discrete area, Ms Mitchell?
Ms Mitchell: It is one discrete area, and in fact half of what I was already going to ask has already been asked by Ms Blackwell, so I can narrow the focus.
Ms Blackwell: Thank you.
Lady Hallett: Ms Mitchell, I appreciate we all get connection problems on occasion, but is this a networking problem common to Glasgow? I gather she is at a university.
Ms Mitchell: I think I’ll probably just say no comment, my Lady.
(Pause)
Lady Hallett: Ms Freeman, can you see and hear us?
Ms Jeane Freeman: I can. Thank you.
Lady Hallett: Thank you.
Ms Jeane Freeman: I apologise again, I think it’s the internet at our end that keeps going down.
Ms Blackwell: Ms Freeman, I was asking you if you agreed with the audit that the progress in relation to the recommendations from the various exercises and the implementation of what was being advised had been slow?
Ms Jeane Freeman: I think my response to that would be that in some areas it was not slow, and in some areas there was important work done, not least the Scottish standards in terms of resilience and the risk assessment that I mentioned earlier. But it is fair to say that not all of the recommendations had been implemented or completed by the time the Covid pandemic struck.
Counsel Inquiry: There was no plan to respond to any other pathogen than influenza, was there, in Scotland?
Ms Jeane Freeman: No, there wasn’t. There was certainly an understanding of different pathogens but, as you said, the Covid-19 was a novel virus, so its exact characteristics and how it would perform and transmit was unknown internationally, and so information and clinical assessment of that was being updated regularly and frequently.
Counsel Inquiry: But there was no plan to respond to any emerging infectious disease, was there, Covid or otherwise?
Ms Jeane Freeman: But there was the plan to respond to flu, to a flu pandemic –
Counsel Inquiry: Yes, but not to any emerging infectious disease other than influenza?
Ms Jeane Freeman: Well, there had been updated actions in response to both MERS and SARS, and in terms of H1N1, but there was no specific plan for other pathogens, as you say.
Counsel Inquiry: Was the capacity and capability within social care in Scotland a fundamental problem in the run-up to Covid hitting?
Ms Jeane Freeman: So we were – we had information through our Care Inspectorate which requires residential care for adults to be registered with them, and the Care Inspectorate inspects those establishments so we had information about the scale of the residential provision, and we understood from our local authority colleagues adult social care provision to people in their own homes. So we had no reason to think that the scale of provision was inadequate and, because of the inspection regime, had a basis for believing that basic infection prevention and control measures were understood across both in-home adult social care and residential social care.
Counsel Inquiry: Was there problems with capacity and capability within the NHS services in Scotland leading up to the pandemic?
I’m thinking in particular of those issues that were identified in the Auditor General NHS in Scotland 2020 report, my Lady, to which Caroline Lamb referred during the course of her evidence.
Ms Jeane Freeman: So there were of course, as there always are, pressures on NHS capacity, and there had been clear recommendations from previous exercises about the importance of NHS staff understanding PPE requirements, which includes not only the PPE equipment to use but also the donning and doffing of PPE, and there had also been recommendations around the redeployment of staff in response to any particular health emergency. But there were capacity issues because Scotland at that point was also trying to reduce its waiting times, for example, for specific procedures, and also improve its performance in other areas of hospital-based healthcare as well as primary care.
Counsel Inquiry: I just want to take you up on two points that you’ve made there, Ms Freeman. The report from the Auditor General states that Covid-19 has exacerbated the existing financial and operational challenges in the NHS; do you agree with that?
Ms Jeane Freeman: Yes, I think that’s true, but additionally what has exacerbated the challenges is, of course – I believe it has been explained to the hearing before me – how the Scottish budget is devised and therefore decisions of the United Kingdom Government in terms of public spending have a direct impact on the Scottish budget, and the Scottish Government of course cannot borrow and cannot run in deficit.
So the impact of the United Kingdom Government decisions in about the previous ten years, where they undertook a policy of what has been described as austerity, had a direct impact on the Scottish Government budget. Notwithstanding that, the health budget and the budget for social care had increased year on year, but not necessarily increased sufficiently to meet with additional demands but also with other cost pressures around pharmacy, inflation and so on.
Counsel Inquiry: The second issue is PPE. Why, if the issue of stockpiling, providing and fit testing of PPE had been raised in three consecutive exercises, had the Scottish Government not acted upon the recommendations?
Ms Jeane Freeman: So you understand that in Scotland we have a single organisation, National Services Scotland, which operates as the procurement arm for our National Health Service, so we have a single procurement approach. So they had their own pile or stockpile or volume of PPE, and in addition they managed the Scottish share of the national stockpile. Now, I think the key question was whether or not both of those resources were widely understood within health, or within social care; and in terms of social care, up to the pandemic the provision of PPE in primary care and in social care was the responsibility of primary care organisations, be they opticians or GP practice, and in social care, whether that was local government in the provision of adult at-home social care or residential care homes, where the owners of those care homes were responsible themselves for PPE provision.
So there was sufficient PPE at the start of the pandemic, obviously there were serious challenges throughout that, and although it’s fair to say we came close on some occasions, we did not run out of PPE in Scotland.
Counsel Inquiry: In terms of the fit testing of PPE amongst NHS staff, the recommendation to ensure that that was carried out adequately was raised in 2015. We know from the witness statement of Nicola Sturgeon that, at the time that Covid hit at the end of 2019, beginning of 2020, that had not been dealt with sufficiently. Is that the fault of the government and, if it isn’t, where does the fault lie for the failure to implement that recommendation over that period of time?
Ms Jeane Freeman: So the responsibility for ensuring that those recommendations are delivered sits with government. There’s no question of that. Government and health boards and others were under severe pressures, of course, throughout that period, and it is possible that in the prioritisation of resources and effort then this did not feature high enough up in those priorities. There were staff who had been fit tested, but that was not of a sufficient number to meet the demands of Covid when it arrived.
Counsel Inquiry: Lessons hadn’t been heeded, plans hadn’t been updated, assumptions remained unchallenged, and Scotland was not as prepared as it could have been, was it, Ms Freeman, when Covid hit?
Ms Jeane Freeman: There were certainly areas where Scotland could have been better prepared, in terms of the underlying structure and the delivery of all those recommendations, but Scotland, like other countries throughout the world, was dealing with a virus which was unknown and new, so in that sense I don’t believe there is a plan that would have been possible that would have been able in and of itself to cope with Covid-19. What we had was an infrastructure, including our resilience infrastructure – which you’ve heard of – which was the architecture, if you like, that we could rest upon whilst we came to terms – often on a daily basis – with what the impact of Covid meant in terms of health and social care provision.
Ms Blackwell: My Lady, that’s all I ask. I’m going to hand over now to my learned friend Ms Mitchell.
Lady Hallett: Ms Mitchell.
Questions From Ms Mitchell KC
Ms Mitchell: I would like to ask about one issue, which is about the preparation and preparedness of Scotland in relation to PPE, and my learned friend has just touched on the matter, and you have responded:
“So there was sufficient PPE at the start of the pandemic, obviously there were serious challenges throughout that, and although it’s fair to say we came close on some occasions, we did not run out of PPE in Scotland.”
And I think that’s reflected at paragraph 14 also of your Inquiry statement.
I’d like us, please, to turn to the document for the Auditor General report, that’s INQ0001484761, and I would like us to go to page 11 of that, that’s at paragraph 14.
Do we see there that it is stated in this document, put short at paragraph 14:
“There has been a huge global demand for personal protective equipment (PPE) since the start of the pandemic.”
Then reading short, going to the last two lines:
“Therefore, the pandemic PPE stockpile was not enough to fully meet the demands of the NHS. For example …”
There are three examples which have been given which I will just pick from quickly. The first there is:
“Some NHS boards reported shortages of certain items of PPE early in the pandemic.”
That seems to be in contrast to the evidence that you’ve given to the Inquiry today.
Also:
“In a survey of Scottish members carried out in late April 2020, the … (BMA) reported that some doctors did not have access to correct and sufficient PPE. This was highlighted as the most concerning issue for 16% of respondents. Those working in higher risk areas reported shortages of a number of items of PPE, including full-face visors [that being] 29%, and long-sleeved disposable gowns [that being] 16%.”
Finally:
“The Royal College of Nursing surveyed its members in Scotland in April 2020. It found that of those respondents working in high-risk environments, 25% had not had their mask fit tested and 47% [almost half] were asked to reuse single-use equipment.”
So, in light of that, what are we to understand by your phrase “we never ran out of PPE in Scotland”?
Ms Jeane Freeman: So in my answer I need to be clear that I’m not seeking to undermine those surveys at all or what the members of those organisations (connection lost) them. But there is a difference between supply and distribution and, as I said in my previous answer, there’s a couple of important things to understand about how we entered the pandemic and what we had to do in response to the pandemic.
The first of those is that that single procurement arm, NSS, was a procurement arm primarily for NHS hospitals, and that’s how it distributed its PPE. It became very clear very early on that those other parts of health and social care which (inaudible) prior to Covid were their own suppliers of PPE through their own separate contracts, mainly because they are private businesses in many instances, albeit they’re providing a service to the NHS. But because their volumes were small, in the global demand for PPE, they were frankly losing out in that. And so we took a decision that our single procurement arm would procure and distribute PPE to all those places: to primary care, to social care, both care at home and residential care, to opticians, dentists, GP practices. That meant we had an introduce a number of new both ordering and distribution channels, which we did at pace – and my thanks to NSS and to others for enabling that to happen – but what that also meant was that distribution within hospitals also had to change.
If I could give you one example, I operated a practice throughout the pandemic whereby individuals could get in touch with me directly if they believed they had any problems, particularly on PPE, and we had a very specific PPE phone line which was staffed and instances of shortage or unavailability were addressed.
On one occasion I had a very senior clinician from a hospital in Edinburgh contact me to say that he was in the Accident & Emergency Department and they didn’t have the PPE they needed. The daily report that I received from National Services Scotland showed me the volume of each item of PPE that we had in stock, and so I couldn’t understand why he was without what he needed. Investigation that evening revealed that it was there, but it was in a particular cupboard and nobody had told him that cupboard and where it was. So we resolved it.
So I give that example as an indication of a distribution between the volume of PPE that you might hold and the efficacy of how it is distributed out to those who need it, and it was largely in the distribution that we had to constantly update how we did that and improve it, often in response to those surveys and those individual members but also to others using our dedicated PPE helpline.
Ms Mitchell KC: Can I just ask: are records taken of the phone lines?
Ms Jeane Freeman: I believe they were. Certainly what happened was that I was given information each day and one of my ministerial colleagues assisted me in picking up all the issues that were raised and then trying to resolve them and fix any problems that were arising, in real time, so that we weren’t having people trying to work in very difficult circumstances without the protective equipment that they needed.
Ms Mitchell KC: Would you, finally, accept then that not running out of PPE under your definition still meant that many frontline Scottish medical staff didn’t have correct and sufficient PPE and caused, for example, 47% of Scottish nurses being asked to reuse single-use equipment?
Ms Jeane Freeman: Well, I’m in no position to gainsay what that survey says, what I can – and I wouldn’t wish to do so. But what I can say is that where issues were raised, either through the PPE helpline or directly with me or any of my colleagues, we acted in real time to resolve those; and what I know, given that every single day I received an update from NSS on each item of equipment, how much we had, what was on order, whether there were concerns about ordering coming in, and that with another ministerial colleague we invested to set up a domestic supply chain of PPE in those circumstances of high global competition, then I know that we had enough PPE. But clearly we encountered issues around distribution both to where it was needed but also within those locations to the individuals who needed specific PPE.
Ms Mitchell: Thank you, my Lady, I’ve got no further questions.
Lady Hallett: Thank you very much indeed, Ms Mitchell.
Ms Blackwell: My Lady, that completes the evidence of Ms Freeman.
Lady Hallett: Thank you very much indeed, Ms Freeman. We got there in the end, thank you for your help.
And that I think completes the evidence for today.
Ms Blackwell: It certainly does.
The Witness: Thank you.
Lady Hallett: Thank you.
(The witness withdrew)
Lady Hallett: So tomorrow at 10 o’clock?
Ms Blackwell: 10 o’clock, please, my Lady.
Lady Hallett: Thank you.
(3.05 pm)
(The hearing adjourned until 10 am on Thursday, 29 June 2023)