Transcript of Module 1 Public Hearing on 4 July 2023
(10.00 am)
Dr Andrew Goodall
DR ANDREW GOODALL (continued).
Questions From Lead Counsel to the Inquiry (continued)
Mr Keith: Good morning, Dr Goodall.
Dr Andrew Goodall: Bore da, good morning.
Lead Inquiry: Could we commence, please, with the issue of the Welsh Government’s corporate risk register. What are risk registers?
Dr Andrew Goodall: So I would say that we have two different risk registers which are associated in this area. We would have a National Risk Register, which would be in the arena of our hazards and threats, our emergency planning and preparedness, and there would be a route for reviewing those.
We would – we also have our corporate risk registers in the organisation, which tend to capture a much broader range of risk areas, issues which have to be addressed by the organisation. So that can include matters of workforce, matters of delivering government policy, but the running of the organisation. So I would say there’s a difference between those two approaches, but we use both.
Lead Inquiry: The first one, the National Risk Register, the Inquiry has heard evidence, in the main from Cabinet Office witnesses, in Whitehall, concerned with the production and maintenance of a United Kingdom risk register which sets out a number of risks, I think there are over 100 now in the NSRA, the latest variant of the National Risk Register, and the Inquiry’s also heard evidence from Scottish witnesses in relation to the maintenance of a Scottish risk assessment process.
Is there an analogue for Wales in terms of the risk register?
Dr Andrew Goodall: So we use the National Risk Register, and that would be consistent with the advice that you’ve had from Cabinet Office colleagues. There are risk registers which are used at the local resilience forum level and they are part of those local and regional arrangements. There is no intermediate Wales hazards and threats risk register which draws those together. The Wales risk – Wales Resilience Forum will oversee those arrangements but we try to allow that to be focused at the local resilience fora level deliberately, with our four fora in Wales.
Lead Inquiry: There are risk assessments and risk assessment plans at the local resilience forum level?
Dr Andrew Goodall: Indeed, yes.
Lead Inquiry: In the same way that there are risk assessment plans at the local resilience forum level in England?
Dr Andrew Goodall: (Inaudible)
Lead Inquiry: There happen to be more local resilience forums in England than there are in Wales, there are only four in Wales, but that is the local risk assessment process?
Dr Andrew Goodall: Yes.
Lead Inquiry: Focusing on the national level, risks which present themselves to the United Kingdom and England are not necessarily the same risks that may present themselves to Wales, because you might have a particular form of threat or hazard in Wales, I don’t know, a particular form of flooding or a particular locality which might be flooded, and therefore a different risk to that which may develop in relation to parts of England or the United Kingdom generally?
Dr Andrew Goodall: Yes, I would agree. The broad range of risks and threats would be consistent, but of course there would be some geographical differences in the Wales context. I think because we only had – we only have four local resilience fora, we didn’t feel that we needed to really work those through, although the Wales Resilience Forum does have a programme of work that will highlight those risks that emerge. But I would agree with you that – you know, where we are now, you know, we are introducing a Wales risk register, and it’s for the very points that you say, that irrespective of health areas and preparedness, there are some more unique issues. For example, coal tip safety in Wales, and some of the, you know, natural resource issues as well.
Lead Inquiry: I can’t recall when Scotland introduced its own Scottish risk assessment process, but on the premise that it was some time ago, has the Welsh Government specifically considered the merits of a Welsh risk assessment process over the ten or so years from the inauguration of the risk assessment process in Whitehall, which I think was 2010?
Dr Andrew Goodall: I think certainly with the transfer of responsibilities in 2018, I think that was in our thinking to look to convert it, but in some respects we were not looking to, at that point, duplicate some of those UK-wide areas, because it felt that they were providing the appropriate backdrop to the hazards and threats that we were facing at that time.
In terms of our current thinking, and indeed reflecting on our own lessons and actions that we’ve adapted, that is absolutely part of our thinking now that we do need to represent it in that way, so there is a Wales risk register in respect of those hazards and threats under review at this moment by the current resilience team.
Lead Inquiry: You refer to thinking; is there any guidance or paperwork to which we may refer ourselves where this issue has been specifically considered by the Welsh Government?
Dr Andrew Goodall: No. I would have expected that, as we absorbed those responsibilities in 2018, it would have formed a pattern of work to review, not because that was being pressed at that time, but the reality was, in 2018, our resilience attention had just switched and we weren’t able really to discharge some of those early expectations from sector assurance plans, so there is no documentation as such, but I know there had been some thinking over that previous time relying on, actually, the individual risk assessments that came up from the local resilience fora, and I said that was translated in document style into the programme of work for the Wales Resilience Forum.
Lead Inquiry: Dr Goodall, I’m sorry to press you, you say there was a pattern of work and thinking was done in a document style; was a document drawn up in which the issue of –
Dr Andrew Goodall: No.
Lead Inquiry: – a Welsh risk assessment was debated?
Dr Andrew Goodall: No, I’m just reflecting that there was no document at that time.
Lead Inquiry: Right. In hindsight, and it must surely follow because the Welsh Government’s position now is that there is a need for a Welsh-centric risk assessment process, that that was an error? It should really have been done at the time that the Transfer of Functions Order was made in 2018, so that there would be a risk assessment structure to which these new executive functions from Whitehall could be attached?
Dr Andrew Goodall: Yes, it helps the clarity of the functions and responsibilities that moved across, and that helps to clarify a change from support and de facto leadership arrangements into the co-ordination role. So, yes, I would agree. And as I’ve said, you know, our current thinking and experience and activities that are taking place are actually looking to produce an intermediate Wales risk register that reflects our own priorities in Wales.
Lead Inquiry: You’ve now used, if I may respectfully suggest, another euphemism: you’re “looking to produce”. Has the process started of –
Dr Andrew Goodall: Yes.
Lead Inquiry: – writing a risk assessment process for Wales?
Dr Andrew Goodall: Yeah, the resilience team is reviewing and has instigated arrangements to look at a Wales risk register.
Lead Inquiry: Has the decision been made to produce a Welsh risk assessment process and register?
Dr Andrew Goodall: Those arrangements haven’t been endorsed by ministers, but the resilience team have actually been producing a Wales risk register as one of our lessons learnt.
Lead Inquiry: Has that team made a decision on a piece of paper saying “The time has come to seek ministerial approval for the creation of a risk assessment process for Wales”?
Dr Andrew Goodall: The team has not done that, in line with your wording, so no.
Lead Inquiry: So that’s the first part, the National Risk Assessment process. The second part to which you made reference is the corporate risk register.
Dr Andrew Goodall: Indeed.
Lead Inquiry: Is that process in existence because the government, the Welsh Government, like commercial entities and other government bodies, is required to assess what risks may face that particular entity, the Welsh Government, and obliged to identify the steps that are required to mitigate the risk to ensure that the consequences that would normally flow from that risk developing can be addressed?
Dr Andrew Goodall: Yes, in respect of Welsh Government as an organisation, and in respect of capturing the risks and issues that the organisation is facing itself, yes.
Lead Inquiry: Could we have, please, INQ000128968.
Is this the corporate risk register for the Welsh Government in July 2014?
Dr Andrew Goodall: Yes, it is.
Lead Inquiry: If we could go to page 5 and row P5, thank you – so page 6 actually.
P5 says “Resilience (Major Emergencies):
“If we fail to provide leadership to ensure Wales is prepared for and resilient to the full range of national hazards and threats, including pandemic influenza, terrorism, major flooding, severe weather and currently the impact of the fire fighters’ industrial action, then there is a risk to the health and well-being of the citizens of Wales.”
Then if we could go back up to page 6 and the bottom half, the document sets out, does it not, mitigating steps, so things that need to be done in order to make sure that that risk doesn’t develop into reality? And the controls are: comprehensive governance structure; links with responder agencies, liaison; investment in facilities and communications; emergency contact arrangements; the existence of a pan-Wales response plan; ministerial agreement to strategies, in particular the 2011 document; and Welsh Government-led pandemic influenza group meetings.
So all, I suppose, the various moving parts of the Welsh Government and what it’s doing in relation to meeting the risk of pandemic influenza.
Can you tell from this document, Dr Goodall, what the overall view was of the state of those mitigating actions? So does the document tell you whether or not the Welsh Government believes that it has adequately addressed the risk by virtue of its mitigating actions? Is there a reasonableness or a critical review of the overall state of play in this document?
Dr Andrew Goodall: It sets out the initial assessment of the risk, which is the score of 20, that scale runs up to a maximum of 25, and it provides the score on the right-hand side after those actions have been deployed, which, allowing for the actions that are set out under the control section, gives that a residual score of 12. So whilst they don’t read across individually and directly to that number, they would be capturing a rounder view that there was a sense of assurance about the actions that were taking place at that stage, and this would have been in the run-up to some of the Exercise Cygnus-type arrangements at that time.
Lead Inquiry: Can you tell from the colour-coding on the right-hand side the degree of reasonableness of the actions that were being taken? So is this a category red, “Major risk, impossible to mitigate”, or an orange risk, which is, “That’s all right, we’ve identified reasonable mitigating steps and we think the risk has now reduced”, or is there some sort of other categorisation?
Dr Andrew Goodall: No, it would be your latter description, which would be indicating that there was a view that those mitigating steps would have reduced the overall risk assessment score.
Lead Inquiry: To what sort of level?
Dr Andrew Goodall: To –
Lead Inquiry: And –
Dr Andrew Goodall: – an amber level.
Lead Inquiry: What does amber mean?
Dr Andrew Goodall: Amber means that – need to keep it under observation, under consideration, it’s not at the highest level of escalation for actions.
Lead Inquiry: All right.
Can we now move forward, please, to the analogous entry for June 2019, just before the pandemic.
INQ000215558, please. If we could scroll in so that we may read it a little more clearly.
For quarter 1, 2019 to 2020, the risk is identified as a:
“Disruption Event, Affecting People, Places, Finances, Communications and IT.
“If there is a significant disruption event (whether an ‘act of god’ or planned attack/event) the Welsh Government may struggle to recover its operations quickly and effectively so that continuity of business critical activities is lost.”
The mitigating measures are now identified as: the existence of a “Business Continuity Plan”; in very broad terms, the disaster recovery plans are in place; the assertion that “Lessons are learned from disruption events”; and the claim that “Emergency response protocols are in place and are practised through desk top and live exercises”.
So a number of questions, please, Dr Goodall.
Firstly, why has the identification of the risk become so much more broad and opaque by 2019? There is no specific consideration of pandemic influenza being a risk and therefore no specific consideration of what mitigating measures might be necessary to meet that risk; why was that?
Dr Andrew Goodall: Yeah. So there was a change in the development of the corporate risk register, from the earlier version that you’ve showed as part of the evidence, through to, I think it was 2017, 2016/2017, when the risk register had been reviewed and set out more in the context of the specific issues that were relevant to the running and operation of the organisation, and this disruption event description was translated, therefore, into: could the organisation reassure that it was able to instigate its own arrangements, so its own internal business continuity plans, that it was able to have disaster recovery arrangements for IT, and became more internally focused in respect of a smaller range of risks that were set out in the risk register at the time.
From my personal experience, because I was the Director General for Health and Social Services, we had actually included pandemic flu and other health emergencies preparedness within the context of our group-based risk register, and I think rightly, whilst of course that would touch on some of those internal areas, because of our oversight of the system, we actually did need to make sure that we were covering off those pandemic flu risks in that arena, and they were consistently described in there. But there was a shift in the corporate oversight and the way in which the risk register was put together. So this is: can we set up the emergency co-ordinating centre? Do we have a rota in place? Do we have our own resilience plans internally? And looking at it for the internal operation of the organisation.
Lady Hallett: I’m sorry, Dr Goodall, I don’t follow. Wouldn’t a corporate risk register always focus on the operation and running of the business with specific issues relating to it? I’m not following what you mean by it changed, other than it obviously did change.
Dr Andrew Goodall: It changed to look at the way in which the civil service itself would step up in the emergency context, and also recognising that emergency planning and response over time had been limited to individual and almost rare events. We’d seen a pattern of requiring our contingencies arrangements to kick in much more often and using our internal co-ordinating arrangements. So there was a decision that was taken corporately reflecting on risk register arrangements and that decision was manoeuvred through. It was a much smaller list of corporate risks that were held at that level.
Mr Keith: Dr Goodall, can I ask you, as you answer, please, just to slow down a little.
Dr Andrew Goodall: Of course.
Lead Inquiry: You’re going very fast for the stenographer.
Dr Andrew Goodall: Of course.
Lead Inquiry: Dr Goodall, this is a risk register for the entirety of the Welsh Government, is it not? It is the Welsh Government corporate risk register?
Dr Andrew Goodall: Yes, it’s the Welsh Government risk register for the operation of the civil service of the organisation, yes.
Lead Inquiry: Yes. Risk registers are meant to identify risks facing the particular body to which the risk register relates, namely the Welsh Government and its administration and governance. Influenza pandemic was generally regarded as the greatest risk facing the nations of the United Kingdom; it was a Tier 1 risk in the United Kingdom risk register. So why, if that is – if it is or was the greatest risk facing, generically, the Welsh Government, was the consideration of that risk, the detail of that risk, the proposed mitigation of the risk, the actions required to meet that risk, downgraded by virtue of being put into the Health and Social Services Group risk register – which is not the Welsh Government, it is one part of the Welsh Government, it is the health and social services part of the Welsh Government – and necessarily then taken out of the generic corporate risk register?
Dr Andrew Goodall: Simply, at the time the risk register was developed to be more generalised about the response, because of the pattern of experiences of other events happening and the need to step up the Wales resilience arrangements. So that was the decision that was taken at the time in development.
Lead Inquiry: Do you accept, Dr Goodall, that the inevitable consequence of that decision was that whilst the civil servants and ministers in the Health and Social Services Group part of the Welsh Government would have been thereafter focusing on the risk of pandemic influenza, because it was then in their risk register, nobody outside that group would have been required to focus for the purposes of the risk register on pandemic flu on the part of the Welsh Government, because it was no longer in the risk register?
Dr Andrew Goodall: I don’t feel that represents the position, because there was a lot of preparedness activity taking on. I know that Cabinet received updates in 2018 and in fact had instigated sector resilience plans from all of the sectors in Wales, which were explicitly on pandemic flu, and that would have reflected the seriousness and the high level of risk associated with it.
But there is a danger in looking at the risk register that whilst it covers a series of individual areas that you would lose some of that expectation within the organisation if you weren’t able to report up those concerns from the health group, I agree.
Lead Inquiry: You make, if I may respectfully suggest, a good point, which is that of course work and preparation continues by-the-by, but would you agree that if you take out of a formal quasi-legal document which is designed to ensure that the leaders of the Welsh Government focus on the greatest risks which face the government as a whole and the people of Wales, there will inevitably be a tendency to take your eye off the ball, because nobody is saying, “Right, what must we do? Our own risk register says this is the greatest threat or hazard that we face, we must focus specifically on what we’re doing to meet it”?
Dr Andrew Goodall: I’m concerned that it is possible that organisations would shift their attention. I would hope that the manner in which we continue to focus on the hazards and threats and that risk profile in terms of the oversight of the Wales Resilience Forum would have kept that attention, and certainly we continued with our preparedness activities through that period of time.
Of course I had the opportunity to raise any additional concerns from the Health and Social Services Group perspective because we were overseeing those arrangements within the detail of those plans as well where pandemic flu did feature.
Lead Inquiry: Mr Vaughan Gething, who was, firstly, Deputy Minister for Health and then subsequently, until 13 May 2021, Cabinet Secretary for Health, Well-being and Sport, has provided a statement to the Inquiry in which he says this:
“… preparedness was not a particular focus of interest or concern in government, the Senedd or outside, and I do not remember any significant questioning on the topic either in government, the Senedd, in the media or elsewhere.”
Elsewhere in his statement he says:
“… preparedness had not featured prominently before in my work, that changed when I had a part in Exercise Cygnus.”
That would tend to suggest, Dr Goodall, that at a high general level, whilst individual parts of the Welsh Government were getting on with doing what they felt they needed to do for preparing the Welsh people for the Tier 1 risk of a pandemic influenza, there was an absence of particular focus by the government on preparedness; would you agree?
Dr Andrew Goodall: I know the minister was very personally involved in Exercise Cygnus, but we would have taken some confidence and at that point the moderated scores, but I note the minister’s statement and we would have raised those issues with the minister if we had had significant concern about our response and preparedness at that time. But I know that he obviously had reflected, given his involvement in Exercise Cygnus, about its significance.
Lead Inquiry: Had the risk rating for disruption events, including pandemic influenza, gone up between 2014, the first chart we looked at, and 2019 to 2020?
Dr Andrew Goodall: The –
Lead Inquiry: The overall risk rating and whether or not the risk had been mitigated.
Dr Andrew Goodall: The overall risk score stayed at the same very high level.
Lead Inquiry: What about the risk score after the mitigating events are taken into account?
Dr Andrew Goodall: The mitigation score had dropped from 12 to 8 and, as I said, we had used that more in terms of the internal triggers for business continuity, so there was a different assessment, but the score had gone down from 12 to 8.
Lead Inquiry: What does that mean, that the score had gone down from 12 to 8?
Dr Andrew Goodall: It means that, in respect of the mitigations and that more general view, there was a view that those areas would give a degree of confidence about the responsiveness of the organisation and the triggers that we’d utilise internally in the organisation.
Lead Inquiry: May we be clear, please, Dr Goodall. The reduction from 12 to 8 signified an appreciation or acknowledgement by the Welsh Government that the mitigating features, the measures it had identified to meet that risk, were no longer as effective as they had been in 2014; their impact had been diluted. Is that not right?
Dr Andrew Goodall: The score here would mean that there would have been more confidence that the arrangements were working. That would have come back on experience of instigating some of these arrangements, like disaster recovery, over that previous time. So it’s a lower residual score, it was at that time showing a high level of assurance.
Lady Hallett: The risk has gone down from 8 out of 25. The state of preparedness has got better according to this risk register.
Dr Andrew Goodall: Indeed, yes, it had dropped from 12 to 8, yes.
Mr Keith: Was that in part because further actions were identified as having been – or actions were identified as having been put into place, a business continuity plan, generically disaster recovery arrangements were in place, lessons were being learned, and response protocols were in place? Is that why the overall risk had gone down, because those things were being done?
Dr Andrew Goodall: Yes, it was, and also, as I say, because of that broader use of it as being the internal trigger rather than a cross-Wales trigger.
Lead Inquiry: But the reality was different, was it not, because, as you agreed yesterday, the major civil contingencies planning documents, the communicable disease plan, the 2011 strategy, the Health and Social Services Group pandemic influenza response plan, none of them had been updated since 2014, the Transfer of Functions Order in 2018 had taken place, but the Welsh Government did not have the full resources, the capacity or the structural system to be able to accommodate those changes of executive function, not all the recommendations from Exercise Cygnus or Taliesin had been implemented, and the workstreams that did take place throughout 2018 and 2019 were significantly interrupted by Operation Yellowhammer?
So how can those control or mitigation measures have been properly advanced as a reason for mitigating the overall risk?
Dr Andrew Goodall: Yes, in hindsight on those scores, with the experience we went through, that residual score, despite those broader areas, should have been higher, but it wasn’t at the time.
Lead Inquiry: But, Dr Goodall, somebody compiling or somebody in the Welsh Government would have known when this risk register was being compiled that those mitigation measures were to a large extent chimera, they simply didn’t reflect the reality of the position on the ground, did they?
Dr Andrew Goodall: I think they were genuinely reflections at the time about the way in which we had worked through various internal arrangements, including business continuity. We’d had experiences around disaster recovery and it would have been demonstrating some assurance from the teams at that time, but I obviously can’t change the score that is there at that time.
Lead Inquiry: Do you agree that those mitigation measures were not accurately described in that risk register? At quarter 1 of 2019, those mitigating measures did not reflect the reality of the absence of work within the Welsh Government in terms of the updating of the planning, the guidance, the resourcing, the response to the exercises, or the capacity to meet the Transfer of Functions Order?
Dr Andrew Goodall: I think personally, in hindsight, that should have been a higher residual score, yes.
Lead Inquiry: Yes. Therefore those mitigating measures identified there are inaccurate, they were simply not an adequate reflection of the reality?
Dr Andrew Goodall: They are generalised statements, but they would have been –
Lead Inquiry: They are –
Dr Andrew Goodall: – business continuity arrangements that were referred to as part of that as well, but, as I said, the residual score in hindsight should have been higher at that time, I agree with you.
Lead Inquiry: Dr Goodall, they are either inaccurate or they are too general.
Dr Andrew Goodall: Yeah.
Lead Inquiry: Which is it?
Dr Andrew Goodall: I think they were too generalised, and that probably gave some inappropriate assurance on arrangements in there. Within the Health and Social Services Group plan, we were able to highlight some of the higher level of actions that were taking place on behalf of the sector, and I hope that that would have mitigated some of that in terms of the way we worked our way through those.
Lead Inquiry: Briefly turning to some of those plans and the guidance, do you agree that the 2011 strategy, the UK pandemic influenza strategy, was not updated before the pandemic struck, insofar as Wales was concerned, and that, as it happened, doctrinally, strategically, it contained, as the evidence now very plainly establishes, a number of flaws; would you agree with that proposition?
Dr Andrew Goodall: I agree it wasn’t updated, and I do agree, given the emergence of novel coronavirus pandemic, that there were a number of assumptions in there that directed us to not plan for a range of areas, and that might have included mass gatherings, non-pharmaceutical interventions. We would have been reliant more in a pandemic flu response for a series of opportunities to treat, to vaccinate, to use antivirals, almost as an initial response, and we simply didn’t have that within the coronavirus response. But I do agree that there were a range of areas in there which were not looking to contain mechanisms, and therefore more focus on those non-pharmaceutical interventions would have genuinely helped in the response.
Lead Inquiry: Were all the pan-Wales or Wales-centric health emergency pandemic influenza-related guidance documents all similarly tainted by that strategic error? So presumably the 2011 strategy, which was a UK document, was looked at by the Welsh Government, which would then rely upon it for the purposes of drawing up its communicable disease guidance, its Health and Social Services Group pandemic guidance, its civil contingencies guidance, its pan-Wales response plan, and so on, but they were all drawn, weren’t they, strategically from that original single United Kingdom document?
Dr Andrew Goodall: Yes, the UK document directed and was the framework that we all worked within. It set out the strategy, and that would have translated through. It would have been different with some of the arrangements like the outbreak plan for Wales, because, given the particular focus there, there would have been a focus on containment rather than the pandemic flu principle, which was an expectation that it would get to a level of community transmission.
Lead Inquiry: Therefore, because the 2011 strategy failed to recognise through the inherent unpredictability of respiratory viruses that there may be a non-influenza catastrophic outbreak with different incubation periods, different transmission levels, different viral load impact, none of those issues or the associated countermeasures that might have been drawn up to deal with those problems were addressed in any – as with Scotland – pan-Wales documentation?
Dr Andrew Goodall: Yeah, there was a strong focus on beyond the detection and assessment stage to be able to use, in a pandemic flu context, treatments and antivirals and to deploy those, and that was unavailable to us with the coronavirus pandemic.
On the updating of documents that you raised, we did update the pan-Wales response plan in 2019, we updated the health group response activation in 2019 as well, but it would be right to say that even if we had updated the plan back in 2018, I don’t feel that those underlying principles would have necessarily changed at that point. Of course, even if we had updated them in Wales, we would have updated them again because of a UK set of changes.
Lead Inquiry: Whatever the variants, whatever the updates, they were still harnessed to that strategic yoke from the original document?
Dr Andrew Goodall: Indeed.
Lead Inquiry: The inevitable consequence of all that was, wasn’t it, that in the early weeks of Covid – and I refer now to a statement from Mr Kilpatrick – it became absolutely apparent that the model which had to be drawn up from scratch in the early days of February and March 2020 simply didn’t align with the Public Health Wales Communicable Disease Outbreak Plan, which of course was the sole plan that Wales was relying upon for dealing with a communicable disease outbreak? It just didn’t help them at all.
Dr Andrew Goodall: Yeah, the outbreak plan would have tended to have been focused on outbreaks in a more local setting and would tend to be discharged within the local resilience fora setting, and obviously the translation to a national level would have been something different.
Certainly in, you know, reviewing the infectious diseases emergencies plan for Wales, that also was not really focusing on the broader sort of societal issues that were under review by the UK pandemic flu plan, and that, equally, would have needed us to step in differently at that kind of national level.
I mean, my view is that we were using the plans as the basis of our response, that it gave us foundations, and certainly that would be true of the pan-Wales response plan, but we had to adapt very quickly to the emerging situation and with the knowledge that was coming through very, very quickly at that time.
Lead Inquiry: All right.
Now, may we then turn, please, to plans – away from plans to exercises.
The two major exercises with which we need to be concerned are Exercise Taliesin and Exercise Cygnus, are we not?
Exercise Taliesin was in 2009. Was that a Welsh Government or a United Kingdom exercise?
Dr Andrew Goodall: That was actually a United Kingdom exercise. We discharged it very significantly, though, in Wales. I actually remember being part of that exercise at the time, because I was two years into being a chief executive.
Lead Inquiry: Was that an exercise which took place contemporaneously with the swine flu outbreak and therefore was able to pick up some of the lessons that were learnt necessarily from the outbreak itself?
Dr Andrew Goodall: Yeah, it almost immediately went into the early part of the swine flu outbreak, as the exercise was taking place, literally within 24, 48 hours.
Lead Inquiry: Could you describe for us, please, the width of that exercise, how significant it was in the general pantheon of exercises? Because it was in two parts, I think. The first part addressed the technical and procedural aspects of communications between local resilience forums, the four resilience forums in Wales, and the strategic co-ordinating centres, which deal with the response, as opposed to planning; and the second part of the exercise appears to have been – and it took place on a single day – with examining the strategic decision-making of the strategic co-ordinating groups. So it appears in general terms to have been addressing the mechanics and the working practices of that lower level in the civil contingencies structure, the local level. Is that a fair summary?
Dr Andrew Goodall: Yes, at the time I was a local health board chief executive and would have had involvement in those arrangements and through, you know, my organisation at the time. But, yes, it was looking to test the resilience of those local agency relationships and absolutely in the context of the local resilience fora structures as well. Of course that was up through the co-ordination mechanisms up at the Welsh level as well.
Lead Inquiry: So the exercise didn’t address directly the workings, in fact, of the central Welsh Government, so the workings of the Cabinet of the First Minister or the directorates, including Health and Social Services, or that part of the government, but of course they were the bodies that would receive whatever information was coming from the local resilience forums and the strategic co-ordinating groups?
Dr Andrew Goodall: Well, I would say “and”. I think they were absolutely focused on ensuring that those local resilience arrangements worked and responder organisations were part of it, but in the context of working in Wales, the structures would have come together at the national level as well, and there would have been involvement at that time from the Health and Social Services Group, its equivalent.
Lead Inquiry: Could we have, please, INQ000128976, which is the report from that exercise. Exercise Taliesin/swine flu structured debriefing report, it took place in the Emergency Coordination Centre on 18 November 2009, although there was an earlier day, as I suggested, I think, in April where –
Dr Andrew Goodall: There was.
Lead Inquiry: – there was an exercise from 8 till 8 in the evening for the strategic co-ordination groups and local resilience forums. It was prepared for the Wales Resilience Partnership Team, and if we could go, please, to page 13, I think we’ll find the recommendations or conclusions. If we could scroll back out, please, at the bottom of the page:
“The following conclusions are based on the issues raised at the workshop for swine flu and Exercise Taliesin …
“In spite of pandemic flu being known as the highest risk and with considerable investment being made in recent years to ensure that the UK is prepared to cope with such an event, a number of gaps were exposed in plans which need to be addressed ahead of a more serious pandemic. These issues in particular are …”
Then if we could – could we scroll back out so that we can get our steps in relation to – our bearings in relation to the particular areas: excess deaths, social care, schools and early years settings, and – over the page – information gathering, cultural approach based on the worst-case scenario, and overall the response to swine flu did not fully test the plans in place.
So there were some quite serious issues arising out of Exercise Taliesin on the areas which I’ve identified.
To what extent were those areas still the focus of concern at the time of Exercise Cygnus held in Wales for Wales alone in 2014, four years later? So were all these issues addressed or did they continue to pose concern by the time of Cygnus?
Dr Andrew Goodall: Yeah, whilst actions had taken place on those areas, looking at the list – I haven’t got the whole list in front of me at this stage, but there were still concerns expressed about clarity of school closure proposals, as I’ve already indicated that is something that would also go back to some of the founding principles of the 2011 pandemic flu strategy. The social care responsiveness and capacity in there, albeit that there would have been actions aside from emergency planning that we would have undertaken to have an understanding of capacity in social care. It’s not line managed like the NHS, so it’s a different flow of information. And on the excess deaths, whilst I know that there was work that took place at that time, it still seemed that with Exercise Cygnus we still needed to provide clarity, and a lot of that was around the changing assumptions or the challenge to some of the assumptions about potential deaths as well. So I think that was always a point of modelling that seemed to be asking for more assurance in the system as well, and that was repeated for Exercise Cygnus.
Lead Inquiry: If we look at the Cygnus recommendations, they are in INQ000107136.
This is the recommendation document that came, as I’ve suggested, from that first part of Exercise Cygnus; when the United Kingdom adjourned or delayed its own Exercise Cygnus, Wales went ahead with its part of Cygnus in 2014. We can see that the first paragraph refers to the fact that a Tier 1 UK exercise was meant to be held in October 2014 with three phases. There were initially 11 scheduled – local resilience fora scheduled to participate in England, but they didn’t, of course, because that was put off, while Wales had all four of its local resilience forums agreeing to take part.
If we could scroll back out, please.
Strategic objectives were identified and then “Exercise Play”, the workshop, is identified, and then right at the bottom of the page we can see that the main cross-government element scheduled for the week commencing 13 November was postponed.
Could we then go to page 2, please.
“Exercise Outcomes”, a number of issues were raised dealing with excess deaths, so that was still an issue by the time of Exercise Cygnus, as you’ve just rightly acknowledged.
“Communication – information demands and situation reporting needs to be centralised to reduce duplication … There needs to be consistency of messaging across the board …”
Does that mean communication in the sense of media and dealing with the public, or communication between the moving parts in the civil contingencies structure?
Dr Andrew Goodall: Your latter point, the moving parts of the structures.
Lead Inquiry: That’s an important issue, is it not?
Dr Andrew Goodall: It’s an important issue.
Lead Inquiry: If they don’t communicate, then the system isn’t likely to perform very well in terms of responding to whatever emergencies present themselves?
Dr Andrew Goodall: Indeed that’s true, and whilst different arrangements require different data flows, yeah, the importance of having enough data but also making sure that there is enough time to be acting on the back of that evidence and data as well.
Lead Inquiry: Regulation we needn’t be overly concerned with.
“Resources – There needs to be a national stockpile of resources made available.”
School closures, still an issue. Demands for data collection, still an issue. National pandemic flu service, one SCG, strategic co-ordinating group, expressed concern.
Then over the page, the recommendations – sorry, at the top of the page:
“Vulnerable People – Concerns were expressed over the capacity and readiness of privately owned care homes to have robust contingency plans.”
Then recommendations were made.
So is this the position, Dr Goodall: a number of features which had come out of the earlier exercise had still not been addressed by the time of Exercise Cygnus, and some of them were of considerable importance and went to the centrality of the civil contingencies health response as a whole? These were significant matters.
Dr Andrew Goodall: Yes, some of those would have continued, and I would say that there were activities taking place to understand and address those areas, but they continued to feature. You know, I know, for example, that we were able to take assurance back from local resilience fora on their views of being able to manage excess deaths on modelling numbers, which took place back in, I think, 2018. But I still don’t feel that the work was fully completed even by that point on the back of the Cygnus recommendations.
Certainly on care home understanding of capacity, having clarity on the local government responsibilities and their local business continuity plans for homes was important, and to seek that assurance, but at the national level – and this for me was beyond just the emergency planning response, we did need to have more understanding of simple issues like the numbers of beds available across Wales. So in my Director General role we did commission an exercise to understand that capacity, just to try and have a similar understanding to the way in which we would use some of our NHS data as well, but it was still not to full resolution, I agree.
Lead Inquiry: The issue of the capacity of the adult care sector to cope with the demands of a pandemic was perhaps the most significant failing identified at the time of Exercise Cygnus in 2014, was it not?
Dr Andrew Goodall: Yes, I would agree that that was still an area of concern.
Lead Inquiry: It was the most significant area of concern because it directly went to matters of life and death in the care home sector; would you agree?
Dr Andrew Goodall: Indeed, and it was a serious issue for local authorities and their discharge of their responsibilities, and it was important to keep that focus up. As I said, it’s why we wanted to have a broader understanding of those numbers.
Lead Inquiry: In 2016 the delayed United Kingdom exercise took place, and it was an exercise which Wales participated in because the original Exercise Cygnus in 2014 had only been fairly limited, hadn’t it, and therefore it was obviously desirable that the Welsh Government took part in the adjourned exercise in 2016?
Dr Andrew Goodall: Yes, I agree.
Lead Inquiry: The recommendations from that, insofar as Wales was concerned, were contained in a document, a Wales debrief report, at INQ000128979.
October 2016. Exercise Cygnus had taken place earlier in October 2016, so this is obviously the debrief report.
If we could go, please, just scroll through the first – well, let’s have a look at the first page.
We can see there that the references to the nature of Exercise Cygnus:
“… a Tier 1 UK pandemic flu exercise with full ministerial participation. In Wales, the Exercise began on the 14th … continued on [the] 18th …”
It involved, again, multi-agency groups from all four local resilience forums.
There was a – the main exercise was on the 19th and 20th, with the CMO leading COBR officials at a meeting, leading officials at a COBR meeting, and the Cabinet Secretary for Health, Well-being and Sport, that would be Mr Vaughan Gething, and the Minister for Social Services and Public Health participating.
There is then a reference to the NHS workshop on the 14th, and how the local resilience forum pandemic planning checklist and various injects were considered for the purposes of the exercise.
If we could go forward to the next page, there is a reference to countermeasures awareness workshop. Then if you would bear with me one moment, Dr Goodall.
(Pause)
Lead Inquiry: We’ll go straight to the recommendations page. While we wait for that to come up, is it right that the overall position was that there were – there we are, thank you very much indeed, very sharp attention by our brilliant technician.
Page 4:
“Recommendations
“… 1 – All organisations were asked to review their pandemic plans …
“Recommendation 2 – All organisations to ensure there is sufficient awareness … of what is … within the Welsh National Stockpile.
“Recommendation 3 – All organisations to review their local delivery points and antiviral collection points …”
If we could just scroll further forward one page, we will see if there were any more recommendations, and there weren’t.
So insofar as Wales was concerned, only a small number of the recommendations from the overarching exercise were relevant?
Dr Andrew Goodall: There were more recommendations than that, I think, if you scroll –
Lead Inquiry: Ah, is that because the recommendations were split up –
Dr Andrew Goodall: In sections.
Lead Inquiry: By reference to particular parts of the exercise.
Dr Andrew Goodall: Particular parts.
Lead Inquiry: All right, yes, there we are, page 7. We have recommendations 4 and 5.
I believe there were 12 in all?
Dr Andrew Goodall: There were 12 within the Welsh context. There were 22 obviously when the overall Exercise Cygnus recommendations came through, and I would say that they also remained relevant to us, of course.
Lead Inquiry: Of the 12 recommendations of the overall 22 recommendations, the 12 that were relevant to Wales, how many of those recommendations concerned issues which had still not been addressed from the earlier Taliesin exercise and the earlier Cygnus exercise?
Dr Andrew Goodall: Because of our particular use of this exercise, we hadn’t quite gone into all of those arrangements in that way, but certainly the broader Exercise Cygnus recommendations and the 22, they would have continued to show some consistent concerns that even if plans or activities were taking place they still hadn’t come to the best outcome that would give resilience in those arrangements as well. So we took the Wales recommendations and drew them into the Exercise Cygnus recommendations just for ease of access.
Lead Inquiry: The reality was, wasn’t it, that the concerns about the adult social care sector had not gone away two years later, the communication issue had not gone away, but, in addition, by the time of the Exercise Cygnus report in 2016 there was then additional concerns being expressed about countermeasures, the stockpiling; is that correct?
Dr Andrew Goodall: There was a wish to understand the level of provision that had been made to have assurance on those countermeasure arrangements, but, as part of the Welsh response at the time, we had particularly wanted to test and exercise that, so it didn’t mean that we didn’t have stocks or countermeasures in place, it was just making sure that they were going to be appropriate for the modelling data that was emerging through Exercise Cygnus as well. So that was an intention for us to try and focus particularly on those countermeasures.
Lead Inquiry: Was it at that point that the Welsh Government set up the Wales pandemic flu task and finish group about which you debated the merits of – with my Lady yesterday? Was that the task and finish group that was put into place to try to address such concerns as were coming out – finally out of Exercise Cygnus in 2016?
Dr Andrew Goodall: Yes, they were the practical arrangements. And of course we reached out to the pandemic flu UK arrangements as well and were observing in part of those arrangements and participating.
Lead Inquiry: That task and finish group, as you said yesterday, wasn’t able to finish its work, because, although it identified the tasks, it never finished them?
Dr Andrew Goodall: Also, as I said yesterday, we ended up moving our resilience activity and focus on to other matters.
On the Exercise Cygnus arrangements, 15 of the actions were completed, seven of them were still not marked as complete and under consideration. I can describe how on some of those measures I think that they actually had more significant activity. As an example, there was a draft communication strategy that had been worked on and was available, but it hadn’t been issued. We had worked through a draft extreme surge guidance plan, but at that point it wasn’t issued, it was only in draft and under consideration, so there were a number of areas that we hadn’t finalised or completed, as I said yesterday.
Lead Inquiry: It may be thought, Dr Goodall, that in the event of a disease outbreak in a pandemic, two of the most vital concerns would be the ability to surge your provision of health services, and a second would be your ability to be able to provide adequate care and resource to vulnerable people, particularly those in the care sector, in order to be able to deal with the terrible consequences of a pandemic.
It was those two areas, the surge planning and the guidance and the arrangements for the protection of the adult social care sector, that were not addressed by the task and finish group after 2016, even though those were areas which had been flagged up as long ago before as Exercise Taliesin; correct?
Dr Andrew Goodall: Whilst the extreme surge guidance hadn’t been issued, it was available as a draft, and ultimately we were able to use that when we were responding very quickly to the coronavirus pandemic. But as I indicated, it wasn’t issued.
In respect of the care home resilience arrangements, it was really important to maintain a focus on those arrangements, absolutely, and to make sure we were able to take assurance from the sectors and the systems reporting in to us.
Lead Inquiry: In addition to this incomplete task and finish process, did the Welsh Government, following something called the Pollock review a few years before, which had been a review specifically commissioned to address why it was that lessons weren’t being learnt from reviews and inquiries, set up something called the Joint Organisational Learning strategy, a body called the Wales Learning and Development Group, and then ultimately the Wales Pandemic Flu Preparedness Group, to also look into why learning was not being properly put into place following exercises?
Dr Andrew Goodall: It did do that, and it also led to the arrangements put in place first of all with training, which had been instigated back in 2008, but also the pattern of the annual conferences, both generally for civil contingencies and also for the health sector, that allowed us to be able to draw in those mechanisms with the organisations and the first responder arrangements as well. So they also allowed us to have an understanding of the focus of those activities over that time as well.
Lead Inquiry: But that additional – and I’m sorry, I’ve described it repeatedly as labyrinthine – process itself wasn’t able to ensure that all the recommendations and the learning from the various exercises were put into place, was it?
Dr Andrew Goodall: No. As I said yesterday, there were actions that were incomplete.
Lead Inquiry: In particular, as a result of resourcing problems, we looked at this through Sir Frank Atherton, the strategic decision taken to await work from Whitehall before getting on with doing work in Wales on the pandemic flu preparedness group workstreams, and also because of the diversion of attention away from civil contingencies planning towards the necessary preparations for a no-deal EU exit, those workstreams were never completed?
Dr Andrew Goodall: Yes, you’re right, and we obviously talked about Operation Yellowhammer yesterday, and the way in which it needed to take resources within the organisation, although that did give us some insight into sector resilience plans more generally as part of that process.
Lead Inquiry: Standing back, in relation to the areas of concern expressed after Cygnus, one of the key issues during Cygnus was, as I’ve suggested to you, healthcare demand, the surge in demand for critical care, that work was still being finalised in 2018, but it never reached fruition, did it?
Dr Andrew Goodall: It was still in draft at that time. There had actually been guidance issued on critical care surge earlier, I think back in 2012.
Lead Inquiry: It was never updated, was it?
Dr Andrew Goodall: It wasn’t, no, I do agree with that, although it had been worked on with colleagues and experts within that particular system, but I agree that it hadn’t been updated by that point, but there was critical care surge guidance.
Lead Inquiry: The consideration that it was thought necessary to give to reviewing and amending the pandemic influenza framework for local authorities and social services providers was never complete?
Dr Andrew Goodall: It wasn’t completed, but we did, through our resilience arrangements, take assurance from local resilience fora on their preparedness and also from local authorities as first responders on their arrangements. So there was an assurance link through to whether those organisations felt that their plans were sufficiently resilient or robust.
Lead Inquiry: There was no national resilience structure, assurance structure, put into place in the way that there is in England and in respect of local resilience forums in England, there was no national resilience standard process put into place, a national resilience assurance process by which local resilience forums could be checked put into place either, was there?
Dr Andrew Goodall: There was a self-assessment process for them within the responsibilities the Welsh Government had before 2018, before it had the legal duties. It didn’t have the performance and assurance role, but from 2018 it would have allowed us to start discharging those assurance roles, and there was a sector resilience assurance exercise that was undertaken in 2018, and it was in the context of pandemic flu.
Lead Inquiry: Was there any non-self-assessment, any external assurance process for checking the validity, the worth, the merit of the plans that were being put into place to deal with a pandemic influenza?
Dr Andrew Goodall: It was generally a self-assessment process for LRFs and also for individual organisations. We had used some peer review examples where Welsh local resilience fora would look at each other’s progress and make assessments.
Lead Inquiry: There was in 2018 an understanding that following the Transfer of Functions Order there needed to be a review generally of the civil contingencies structure in Wales; is that correct?
Dr Andrew Goodall: Yes, I agree. We needed to understand how we were going to properly and fully discharge those responsibilities.
Lead Inquiry: What happened to that general review of civil contingencies following the Transfer of Functions Order?
Dr Andrew Goodall: Whilst we had done the sector resilience oversight and we had expanded the team with the new responsibilities coming over, our attention and activity had simply moved across to Operation Yellowhammer and the EU exit arrangements, and that meant that the resilience team was embedded in that work as well as a very large part of the organisation as well. So the discharging of those responsibilities as we intended was put on pause, even though we were using and deploying the civil contingency mechanisms for EU exit.
Lead Inquiry: The inability to carry out that review, of course, an inability which existed prior to Wales being struck by the pandemic, has been described by one of your own ministers as “extremely disappointing”. You’ve seen the reference in Mr Kilpatrick’s statement.
Even after the pandemic struck, when the review of civil contingencies in Wales took place in 2023 – it did earlier this year, did it not –
Dr Andrew Goodall: It did.
Lead Inquiry: – did it then become apparent that there were still flaws in the civil contingencies system, in particular in relation to leadership capacity, effective and continuous training and exercising, a system for the systematic capture of lessons from exercises, the need for an establishment of minimum standards for competency, skills, qualifications, training and development?
Dr Andrew Goodall: Yes, indeed. They remain the themes in those areas and that work is under way to make sure that they are resolved. There is a system that captures the lessons learned now, which is held on an all-Wales level by Public Health Wales, and that is a new introduction since 2017, but we do need to make sure that we embed those arrangements and deal with the actions as well as the culture and behaviour around those issues as well.
Lead Inquiry: So, Dr Goodall, would you agree that, given that many of those issues had been raised consistently, continuously from 2012 onwards, that is an egregious example of locking the stable door after the horse has bolted?
Dr Andrew Goodall: We’ve had to learn many lessons and adapt and, you know, we need to ensure that we keep addressing the issues, from our planning and also from our recent experiences as well.
Mr Keith: I’ve no further questions.
My Lady, you’ve given permission for three areas of questioning to be advanced by Covid-19 Bereaved Families for Justice Cymru.
Lady Hallett: Thank you.
Questions From Ms Harris
Ms Harris: Good morning. I’m Bethan Harris. I appear on behalf of Covid-19 Bereaved Families for Justice.
I have three questions, Dr Goodall, and I have ten minutes, so I’ll be keeping an eye on the time.
Yesterday Sir Frank Atherton, when he was giving his evidence, was referred to a document which had been produced for the Health Protection Advisory Group.
For the reference that is INQ000177362.
I won’t take you to that document, but I’d just like to read, first of all, what he said in evidence.
He was taken to the document and it was introduced to him as a paper prepared for the committee, that’s the Health Protection Advisory Group, in July 2019, six months before the pandemic struck, and the document contained within it this statement:
“The current microbiology/infection services in Wales are fragile and are struggling to deliver on a day to day basis the prevention, early diagnosis and frontline support that professionals and the public require.”
He was asked whether that was not a major concern, and he agreed it was a major concern.
I’d like to ask you about a document that you’ve referred to in your witness statement that you’ve exhibited, and if it could be brought up on the screen, please. The number is INQ000177552.
You’ve referred to it in your third witness statement at paragraph 128.
Hopefully that can be brought up on the screen. Thank you. I think it’s there.
This is a ministerial advice. You see it, Dr Goodall?
Dr Andrew Goodall: Yes, I can, thank you.
Ms Harris: Thank you. It’s addressed to the Minister for Health and Social Services. It’s dated 2 September 2019:
“Subject: Strengthening and improving the National Health Protection Service in Wales.”
Box 1:
“What is the issue you are asking the Ministers to consider?
“This advice summarises the current health protection challenges faced in Wales and sets out the investment needed to meet this challenge and to strengthen and improve our National Health Protection Service.”
Then it goes on to refer to the actions which are being recommended, which are to increase the revenue that’s necessary, and indeed we heard Sir Frank Atherton refer to the request for additional revenue in this area when he gave his evidence yesterday.
I’d like to refer you to what is stated with regards to the context, which is on the next page, if we could kindly go to that on the screen, please, headed “Advice”:
“4. Context – What is the situation that has led to this advice?”
First of all, the “recent terrorism incident in Salisbury” is referred to, uncertainties caused by EU exit, growing threat posed by antimicrobial resistance, increased threat of high-consequence infectious disease, such as Ebola, and then goes on to refer to:
“International and domestic events demonstrated fragilities in all the respective national health protection services operating within the UK, which the responsible authorities in all four nations are seeking to address.”
Then it goes on to say:
“Response to these threats relies on the same physical and human infrastructure which is currently under pressure to deliver basic health protection services. Health professionals in Wales are not confident that they could at all times provide an effective response to high consequence infections or other chemical and biological threats.
“The National Health Protection Service in Wales is fragile; and the service today is confronted by a number of challenges. These include …”
Then, first of all, it refers to UK-wide shortages of trained staff and then:
“- laboratory estates on many sites which are no longer fit for purpose …”
The next bullet point:
“- the need for increased ward-based clinical services and services in the community to support both infection prevention and antimicrobial stewardship.”
It then goes on to say:
“Although microbiology is a shortage speciality UK wide, recruitment to Wales is particularly challenging when the laboratory estate on many sites is not fit for purpose, and a lack of investment in new technologies and redeployment of scientists means microbiologists are unable to spend time on the frontline supporting professionals …”
I’m going to skip the next paragraph. Then finally that:
“Health protection professionals in Wales consider that, adequately resourced, there is much more they could contribute in the prevention, diagnosis and management of infection and in guiding prudent use of antibiotics.”
So that, as I say, is a document that you’ve exhibited, and what I’d like to ask you about is, first of all, do you agree that the document that I initially referred to, the one that Sir Frank Atherton was referred to yesterday, and this particular document, in September 2019, they imply that there was a very real need to improve on infection prevention and control services in Wales at that time in 2019?
Dr Andrew Goodall: Yes, I remember not just the document but the discussion at the time. It was a very honest assessment that had come through that group, also on the advice and expertise of Public Health Wales, and it was really important that we were responding to those concerns about fragility, and the decision was made to support that. In fact the previous year we had actually made some additional financial investment in Public Health Wales in this arena as well.
Ms Harris: Do you agree that, in terms of pandemic preparedness and being prepared for the Tier 1 risk that everyone across the UK, including in Wales, was aware of, that there would need to be capacity to meet a significant increase in need for infection prevention and control services?
Dr Andrew Goodall: Yes, indeed. I mean, the NHS faces day-to-day pressures whilst it’s discharging many activities and supporting its communities. The day-to-day pressures of the service, you know, would need to have some resilience built in to be able to deal with those extra responsibilities as well. So yes, the existing service was under pressure, which was why we were addressing it, but we were also trying to build in some resilience into the system with the investment as well.
Ms Harris: Going to what I think you are saying, and I’ll ask you to confirm, were the two or two of the main pandemic preparedness planning documents – I’m going to ask you whether they actually reflect the importance of infection control and prevention.
First of all, if you can perhaps confirm that the Wales Framework for Managing Major Infectious Disease Emergencies, October 2014, was one of the main preparedness guidance documents that was current in Wales from 2014 onwards, right up to when the pandemic hit?
Dr Andrew Goodall: Yes, it would have covered responsibilities and maybe not gone into all of the detail. Certainly the outbreak plan for Wales would have really dealt with some of the very specific issues in terms of discharging that on a local level.
Ms Harris: Yes, thank you. So that’s one of the documents. It’s right, isn’t it, that that document, the Wales Framework for Managing Major Infectious Disease Emergencies, you may be familiar with its content without me needing to take you specifically to the document, but I’d like to refer you to a passage in it, and it was indeed a passage that was highlighted yesterday, again in Sir Frank Atherton’s evidence. Paragraph 11.1:
“All hospitals need to establish ways of caring for large numbers of infectious patients on a scale outside their normal experience, including those requiring high dependency care.”
So just to confirm, that document clearly recognised the importance of infection control in the context of being prepared for a pandemic?
Dr Andrew Goodall: Yes, I agree.
Ms Harris: Indeed.
The other document is the Wales Health and Social Care Influenza Pandemic Preparedness and Response Guidance, again another one of the major preparedness guidance documents, 2014, that remained in force throughout up until the pandemic hit; yes?
Dr Andrew Goodall: Yes, indeed, yeah.
Ms Harris: Thank you.
Dr Andrew Goodall: We’d hoped to review it in 2018, but it was the document in 2014 that was an important response document for us, yes.
Ms Harris: That one referred to the meticulous use of infection control procedures being part of preparedness and part of what would be needed in the event of a pandemic?
Dr Andrew Goodall: Yes.
Ms Harris: That’s familiar to you. Thank you.
So what I want to ask you is: do you accept that, when we look at what we had in September 2019, in the document I referred you to, which you’ve exhibited, and we look at those documents in 2014 and what they flag up in terms of needs, in terms of infection prevention and control, that there just wasn’t a robust enough process of following up on what the Welsh Government’s own guidance said, that there wasn’t a critical review as to whether things were actually put in place that had been stated in the documents?
Dr Andrew Goodall: We would have worked with individual health boards in Wales who would have used their funding for a variety of areas. Public Health Wales, of course, would have made its assessment, and when it came forward with its national plan we were very happy to support it.
I mean, certainly, and I speak from personal experience as a local health board chief executive, we had tried to ensure that new hospital builds were supporting an infection control outlook, including single room arrangements, for example, but that was not available to all of the estates, and they were certainly possible with new build arrangements in Wales, but we would have worked with individual organisations on their proposals and plans and they would have been able to make some local decisions on that infrastructure as well.
Ms Harris: Right. So you’re saying things were done, but do you accept it wasn’t enough?
Dr Andrew Goodall: When we were receiving that national protection proposal, that was showing that we needed to invest more and have more flexibility and capacity, yes.
Ms Harris: Thank you.
I’m going to just deal with a second question very briefly, because I know that I’m running out of the time that’s allocated. Thank you for those answers.
I’d like to ask you a question on PPE, and perhaps putting to one side matters of what the arrangements were with regards to how much PPE was stockpiled and what was the extent of the actual availability of PPE that was planned and put in place.
The distribution system for accessing PPE and distributing it, was the resilience of that system in Wales adequately tested in advance of the pandemic?
Dr Andrew Goodall: The PPE stockpiles, where we were making sure that we had about 15 weeks’ worth of supply available, were well tested. When we were in the coronavirus response, we really had to utilise the excellence of the national procurement service arrangements to change the distribution model quite quickly.
But to your question, I don’t think that they were rigorously tested. They may well have featured as part of the procurement service’s own resilience proposals. But certainly we adapted very quickly to ensure we could distribute the PPE at least out to the regional centres before they needed to go through to the frontline staff and services.
Ms Harris: Just finally, obviously this module is not looking at what actually transpired and how things played out on the ground in any detail, but do you acknowledge that there were problems with distribution?
Dr Andrew Goodall: We ended up having to change our distribution model, rather than to 11 centres to literally get to hundreds of sites in matters of days, so it was a very different response that was required at the time.
Ms Harris: Right. In retrospect, would it be right to say that there hadn’t been sufficient scrutiny of the resilience of that distribution system in advance of the pandemic?
Dr Andrew Goodall: We were assured on the existing arrangements, but at the scale, the severity and the duration of the arrangements, we would have needed to have done more work based on the experience that we had to the coronavirus pandemic.
Ms Harris: Thank you.
Thank you, my Lady, those are my questions. Thank you very much.
Mr Keith: My Lady, I omitted to ask about one particular area which I know has been of concern to my Lady.
Lady Hallett: The stenographer has been going for a long time. Is it important to deal with it?
Further Questions From Lead Counsel to the Inquiry
Mr Keith: Yes, it’s about the Chief Scientific Adviser system in Wales, and I wanted to ask two questions in relation to that, if I may.
Dr Goodall, it is this: it appears from material that the Chief Scientific Adviser for Health in Wales – a man who is actually, I think, a Mr Rob Orford – because he is concerned with being the Chief Scientific Adviser for Health is not part of the UK Chief Scientific Adviser system; and secondly, do we have it right that, for whatever reason, the Chief Scientific Adviser in Wales and the Chief Scientific Adviser for Health in Wales are not at the centre of the Welsh civil contingency structure, so they don’t actually give advice on civil contingencies to the Welsh Government? Have I summarised the position correctly?
Dr Andrew Goodall: Yeah, you’ve summarised those correctly. There were some changed arrangements put in place during the pandemic itself to access those, but they were – certainly Rob, as the CSA Health, was involved in the pandemic response, but they had traditionally not been directly involved in the preparedness.
Mr Keith: Thank you.
Lady Hallett: Thank you very much, and I shall return at 11.40.
(The witness withdrew)
(11.22 am)
(A short break)
(11.40 am)
Lady Hallett: Ms Blackwell.
Ms Blackwell: My Lady, may I please call Dr Quentin Sandifer OBE.
DR QUENTIN SANDIFER (sworn).
Questions From Counsel to the Inquiry
Ms Blackwell: Dr Sandifer, thank you very much for the assistance you’ve so far given to this Inquiry, and also thank you for coming to give evidence today.
You have prepared a witness statement which we see at INQ000192266. Your signature appears at page 83.
There we are.
You signed this statement on 27 February this year. Can you confirm, please, that it’s true to the best of your knowledge and belief?
Dr Andrew Goodall: Yes.
Ms Blackwell: Thank you.
My Lady, may we have permission to publish it, please?
Lady Hallett: Yes.
Ms Blackwell: Thank you.
We can take that down, thank you.
I’d like to begin by establishing through you, Dr Sandifer, the creation of Public Health Wales. It was formulated in 2009 by the Minister of Health and Social Services, following a review of public health functions undertaken in 2006; is that right?
Dr Andrew Goodall: That’s correct.
Counsel Inquiry: Thank you.
The functions of Public Health Wales are three-fold: it provides data and science-based leadership, specialising in public health expertise and co-ordination and advice, and is a delivery of key public health services; second, it works closely with public health boards, local authorities and other partners, including education and housing; and, third, it protects and improves the health and well-being and seeks to reduce health inequalities. Is that right?
Dr Andrew Goodall: That’s correct.
Counsel Inquiry: Thank you.
The structure of Public Health Wales has a senior management team that has changed in certain respects since its incorporation in 2009, but the chief executive since 2014 has operated a corporate level business executive team structure, where collective decision-making at a corporate level is a key feature, in addition to each director having clear accountability and responsibility for a specific portfolio; is that right?
Dr Andrew Goodall: That’s correct.
Counsel Inquiry: The second key role is that of National Director of Health Protection and Screening Services and Medical Director, a title which was previously known as the Executive Director of Public Health Services, Medical Director.
Dr Andrew Goodall: That’s correct, and I held that latter title from October 2012 until December 2020.
Counsel Inquiry: Thank you.
In your role at executive level responsibility, which we’ll go into in more detail throughout the course of your evidence this morning, is it right that you have now become a consultant adviser for pandemic and international health for Public Health Wales?
Dr Andrew Goodall: Yes, following my retirement in December 2020, I returned in 2021 and undertook that contracted consultancy role on a part-time basis.
Counsel Inquiry: Thank you.
I want to turn for a moment to deal with the funding of Public Health Wales, and to confirm with you, please, Dr Sandifer, that there are two main sources of funding for the organisation: funding from the Welsh Government and other National Health Service Wales organisations who provide remuneration for the provision of services delivered by Public Health Wales?
Dr Andrew Goodall: That’s correct.
Counsel Inquiry: You tell us at paragraph 41 in your witness statement that:
“In exercising its role as functions, Public Health Wales was not held back in any way by the funding made available by the Welsh Government.”
And that, in your view:
“There are no examples of insufficient funding curtailing the ability to fulfil Public Health Wales’ role and functions in a timely manner in relation to the pandemic.”
Is that right?
Dr Andrew Goodall: That’s right.
Counsel Inquiry: Public Health Wales funding increased dramatically from 2009 to 2010, when it was set at £41.5 million, to £152.9 million by the time we reached 2019 to 2020.
What was the cause of that dramatic increase in funding, and why was it made?
Dr Andrew Goodall: Well, the figure that you started with, the £41 million, reflected a half year position, because the organisation was established at the beginning of October 2009. The full year figure, which is reflected in the 2010/2011 accounts, was around £81 million.
The principal reason for the expansion in funding was partly as a result of some transfers of functions that were discharged in other bodies in Wales, transferring in to Public Health Wales, with the funding attached to those, and also in part as a result, likewise, of some service transfers, for example our diabetic retinopathy service was transferred in from a local health board into Public Health Wales and brought with it a substantial amount of financial resources.
Then there were some other additional investments made by Welsh Government during the course of the ten years, including in health protection, but also in other areas like policy, research, international health development.
Counsel Inquiry: Thank you.
Can you confirm, for the purposes of the Civil Contingencies Act of 2004, Public Health Wales is a Category 1 responder?
Dr Andrew Goodall: Yes, it is.
Counsel Inquiry: So as well as having health protection and microbiology responsibilities, it also had an EPRR function, didn’t it?
Dr Andrew Goodall: It did.
Counsel Inquiry: In terms of the allocation of budget for emergency preparedness, resilience and response functions, that increased from 2014 to 2015 and £387,000 to 2020 to 2022, £884,000. Can you explain why there was such a dramatic increase in that part of the budget, please.
Dr Andrew Goodall: Yes. I think it’s fair to say it’s very difficult to tease out what exactly were the financial elements attached to EPRR, because of course EPRR is a function delivered by the whole of the organisation, and in particular from our health protection and microbiology services. But I do recognise those figures, and the reason why there was such an increase is that following the Ebola outbreak in Wales in 2014 to 2016, and on the back of reviews that we undertook both to our emergency planning and business continuity arrangements, we introduced some changes in 2017/2018 including, for example, expansion of our emergency planning support workforce, the appointment of a lead manager, and all of those appointments attracted the need for further investment.
Counsel Inquiry: Right.
Did you think at the time, in 2014 to 2015, that the EPRR budget was sufficient?
Dr Andrew Goodall: I think Public Health Wales discharged its EPRR functions within the resources available to it, but in doing so, at that time, it should be said that the EPRR function was located in our Health Protection Team, and it is probably true to say that it was subsidised by the Health Protection service.
Counsel Inquiry: Well, you tell us at paragraph 196 in your witness statement that “the health protection services in Public Health Wales were under-powered”. What did you mean by that?
Dr Andrew Goodall: So that paragraph refers to our assessment of the initial phase of the coronavirus response.
So, if I could just summarise, perhaps, to help the Inquiry understand the pattern of investment: between 2010 and 2019 there had been no budget cuts and there had been an increase in both the financial resources and the workforce in the health protection and microbiology services, which is where most of the EPRR functions were based and from which they were delivered.
Counsel Inquiry: Right.
Well, just before we leave the issue of finance and budgets, you also tell us at paragraph 78 that in February 2019 the Welsh Government confirmed additional funding for the National Health Protection Service and that there was £1 million capital funding in that year to directly support the automation of the laboratory services across Wales and £0.6 million minimum revenue for the continued development of the Pathogen Genomics Unit. Is that right?
Dr Andrew Goodall: That’s correct, and that reflected, in fact, a series of investments that had been made since 2014 in our health protection and our microbiology services.
Counsel Inquiry: Dr Tracey Cooper, your successor in post, tells us in her witness statement that that funding facilitated enhancements to the microbiology laboratory network and infrastructure, but that those improvements were still being made and implemented at the time of the pandemic; do you agree with that?
Dr Andrew Goodall: If I could just gently correct, Dr Tracey Cooper’s the chief executive of Public Health Wales and had been so since June of 2014, and remains still the chief executive.
Counsel Inquiry: Thank you.
Dr Andrew Goodall: But to your point, yes, that is correct.
Counsel Inquiry: All right. She also told us that that funding was only a part response to the need raised by Public Health Wales for the strengthening of the health protection system across Wales, so she appears to be saying – and please correct me if I’m wrong – that a plea had been made for further investment, and the investment in terms of the laboratory services that was received was only a part response; do you agree with that?
Dr Andrew Goodall: It was. We began our discussions with Welsh Government in the second half of 2017 about what we regarded as the additional investment required to strengthen our National Health Protection Service. This also coincided with what we believed was some necessary investment, such as you referred to, the capital investment, in particular technologies, molecular diagnostics and genomics sequencing in particular. But – and we were grateful for the investment that we did receive, but we had still anticipated and therefore made the case for further investment, which then came through later in 2019.
Counsel Inquiry: Is that partly because in 2017/2018 the organisation identified to the Welsh Government in particular the need to strengthen the health protection system and what Dr Cooper describes as a particularly fragile microbiology service?
Dr Andrew Goodall: Yes.
Counsel Inquiry: All right. Do you agree that at the time and before that investment was made, the microbiology services were particularly fragile?
Dr Andrew Goodall: Yes, that fragility was created in 2015/2016 with the retirement of a number of senior microbiologists and difficulties that we had recruiting to those posts. And the investment that we referred to, the fragility and the investment we referred to, was accompanied actually also by some internal actions we took to strengthen the model for the delivery of microbiology at the same time.
Counsel Inquiry: To what extent did Public Health Wales provide advice to the Welsh Government on its pandemic preparedness?
Dr Andrew Goodall: So Public Health Wales has throughout its existence provided specialist advice and direct support systems leadership to Welsh Government and the wider health, social care and local government system in Wales in respect of EPRR, and so, yes, that included specific advice to Welsh Government on its pandemic planning arrangements, learning and development, exercising and training.
Counsel Inquiry: What level of representation did Public Health Wales have on scientific advisory bodies such as SAGE and NERVTAG?
Dr Andrew Goodall: So Public Health Wales has never been a member – or at least, I’ll put it the other way around. Representation from Public Health Wales, there has been no representation from Public Health Wales on NERVTAG. Likewise, we’ve not had a seat on SAGE pre-pandemic.
Counsel Inquiry: Right. Do you think that Public Health Wales deserved a place on NERVTAG and SAGE?
Dr Andrew Goodall: I do think that it would be beneficial for Public Health Wales to be on NERVTAG. I recognise that SAGE is established in specific circumstances –
Counsel Inquiry: Yes.
Dr Andrew Goodall: – and that government representation would be the most appropriate sitting outside of government. We didn’t presume that that would include us but we would of course always be happy to support Welsh Government had we been asked.
Counsel Inquiry: In terms of responsibility at a local level, Public Health Wales’ duties and responsibilities, and its obligations indeed under the Civil Contingencies Act, meant that it worked closely with local resilience fora; is that right?
Dr Andrew Goodall: Yes, we had representation on four – all four local resilience fora in Wales.
Counsel Inquiry: Did Public Health Wales also chair the Wales Risk Group?
Dr Andrew Goodall: We did. One – the senior manager for our combined – in 2017/2018, we combined our business continuity and emergency planning arrangements. Our business – our manager for that service did lead that group from January 2018 till November 2020.
Counsel Inquiry: What, if any, discussion was there during the meetings of that group about the National Risk Assessment?
Dr Andrew Goodall: So what that group did is it took the National Risk Assessment and then, with Welsh Government and with representatives from the four local resilience fora, considered how that risk assessment applied within Wales and the steps and actions that should be taken, including the inclusion of the risks in local resilience fora, community risk registers.
Counsel Inquiry: Did that also involve an assessment of any gaps in preparedness that might exist at the local level?
Dr Andrew Goodall: We also, as I’ve already said, had representation at the local level, and our representation at the local level included liaising with each of the local resilience fora about their assessed risks and advising them accordingly.
Counsel Inquiry: So how did Public Health Wales have the necessary arrangements in place to effectively support and enable the local resilience fora to make their own rapid and effective responses to the pandemic when it struck?
Dr Andrew Goodall: So Public Health Wales’ Health Protection Team, together with the microbiology service, used our emergency response plan as the basis for our initial response to the pandemic in 2020, and in doing so we were aware that the local resilience fora in turn were standing up their strategic co-ordinating groups, as it appropriate, as a response.
Counsel Inquiry: What is the Wales Resilience Forum and how does Public Health Wales contribute to that?
Dr Andrew Goodall: Wales Resilience Forum is a structure within Welsh Government that is chaired by the First Minister and includes representation from all multi-agency partners at a strategic level to consider the risks across the piece, so not confined only to health, and I represented Public Health Wales as a member of that group.
Counsel Inquiry: How does that sit with the Wales Resilience Partnership Team?
Dr Andrew Goodall: The Wales Resilience Partnership Team was a group underneath the Wales resilience fora, in part providing secretariat functions, and in part tasked with the operationalisation of some of the activities that had been discussed at the Wales Resilience Forum.
Counsel Inquiry: Did you also sit on the Wales Resilience Partnership Team?
Dr Andrew Goodall: I didn’t, but our emergency planning and business continuity manager did.
Counsel Inquiry: Right, thank you.
All right, now having established the body that Public Health Wales became in 2009 and its functions and responsibilities, I’d now like to look at some of the plans that were in place over the course of the Module 1 time period.
First of all, please, can we look at INQ000089558, which is the Public Health Wales Emergency Response Plan.
We can see that this version is version 2, created in September of 2018, and if we go to page 2, please, we can see that under the heading “Sponsoring Executive”, you appear as the sponsoring executive.
What does that mean in terms of this particular document?
Dr Andrew Goodall: What that means is that, as the executive lead for public health emergency planning in Wales, this document was endorsed by me and commended by myself to our board for consideration.
Counsel Inquiry: What was the purpose of this document? How was it intended to be used?
Dr Andrew Goodall: So this document, as it says at the top, provides the specific arrangements for our strategic and tactical response to emergencies, incidents and outbreaks.
It’s the top level document of a suite of documents also that sit with this. It is an internal document, but it has been written very much in the spirit of the Civil Contingencies Act, was shared with and therefore deliberately made known to our local resilience fora partners.
Counsel Inquiry: So they had access to this?
Dr Andrew Goodall: They and Welsh Government had access to this document.
Counsel Inquiry: Thank you.
Can we go to page 9, please, and look at paragraph 1.1. Thank you. We can see here under the heading “Introduction” that:
“The Public Health Wales Emergency Response Plan details the organisation’s response arrangements to any emergency, incident or outbreak that impacts on, or requires the mobilisation of, public health resources and capabilities. The Emergency Response Plan provides a framework to establish, create and improve resilience.”
Did this document replace an earlier iteration, and if so, when was that first created, please?
Dr Andrew Goodall: So this document replaced an earlier version which had been approved by our board in November 2016, and indeed it was about the fifth – I’d have to just remind myself, we had a plan in 2009, 2012, 2014, 2016 and, yes, this would have been the fifth iteration of the plan in 2018.
Counsel Inquiry: It wasn’t updated, was it, until 2022, I think?
Dr Andrew Goodall: That’s simply because events overtook us. At the beginning of 2020, which is – I mean, we review our plans annually anyway. The plan was still, we considered, relevant at the beginning of the outbreak of the pandemic, but we, during the course of the pandemic, recognised that the plan would need updating and at the earliest appropriate time we did so.
Counsel Inquiry: Thank you.
Can we go to page 10, please, and have a look at the roles and responsibilities. We can see that, third row from the bottom – can we just scroll out, please, here we are:
“Facilitate epidemiological follow-up of affected populations and communities as necessary.”
To what extent did Public Health Wales achieve this? What was this intended to represent?
Dr Andrew Goodall: So in an incident, an emergency, particularly in an outbreak, what we always sought to do was to assess the impact of that on the populations affected. We did this during the Covid response, a wide range of assessments were undertaken, including epidemiological assessment. But an example would be: had there been a chemical release from a factory with a cloud of gas discharged and floating over a local population, we would follow – after that event had been resolved, we might well follow up with the affected population to see if there had been any longer term impact.
Counsel Inquiry: Do you agree that within this document, the EPRR information largely focuses on command and control measures and doesn’t include any specific detail on how to handle a coronavirus outbreak, and it doesn’t go into any plan for non-pharmaceutical interventions?
Dr Andrew Goodall: So I think I should explain that this plan, which is an all-hazards plan, it’s a generic plan, was written in the context of Public Health Wales as a Category 1 responder, being able to demonstrate that it was fulfilling the requirements of the Civil Contingencies Act and the duties and responsibilities, including statutory and non-statutory guidance, and that is how this document has been written.
Counsel Inquiry: So is your answer that you wouldn’t have expected that level of detail to be involved or incorporated into a document such as this?
Dr Andrew Goodall: I would expect that information to be in other documents.
Counsel Inquiry: Right. Well, we’ll move to look at other documents in a moment. But before we do – we can take that down, please – I would like to ask you about the Health Protection Advisory Group. That is a group that had been or indeed has been in existence for many years, hasn’t it?
Dr Andrew Goodall: It has, yes.
Counsel Inquiry: And it was – it involved the CMO, the Chief Medical Officer for Wales, but you tell us in your witness statement that there was a period of abeyance of the group before it was re-established in May of 2018. Why was the group put into abeyance, which required it to be re-established in May of 2018?
Dr Andrew Goodall: So the group is a non-statutory advisory group to the Chief Medical Officer, and in 2014 the then Chief Medical Officer retired and the group therefore ceased to meet. The current Chief Medical Officer came into post later in the year, and then, at the beginning of 2018, he decided that he would like to re-establish the group.
Counsel Inquiry: What was the involvement of Public Health Wales in that group?
Dr Andrew Goodall: Public Health Wales has always been a member of the Health Protection Advisory Group.
Counsel Inquiry: To what extent was pandemic preparedness discussed during those group meetings?
Dr Andrew Goodall: So, the group looked at the whole breadth of public health threats and hazards, and Public Health Wales advised and supported the group, for example by preparing technical documents and papers for it to consider, and influenza pandemic preparedness had been one of the subjects of discussion in the group.
Counsel Inquiry: What was discussed about it?
Dr Andrew Goodall: So we had been aware that in 2016, or 2014, as has been discussed already, there had been an exercise in Wales and that there had also been an exercise at the UK level that Wales had participated in, and that had generated recommendations and outputs which needed to be followed through.
Counsel Inquiry: So did Public Health Wales become involved with the recommendations that fell out of Exercise Cygnus and the other exercises that ran before that, which we’ll turn to look at in a moment?
Dr Andrew Goodall: So when Exercise Cygnus took place, Public Health Wales had two representatives observing. When the report was published in July of 2017, we obviously received a copy of that report and, as was shown yesterday, a Wales influenza pandemic preparedness group was convened, meeting first in September that year, and Public Health Wales was represented on that group.
Counsel Inquiry: All right. Well, we’ll come to look at that in a moment.
Before we do, let’s just have a look at a set of meetings from this group, from 17 December of 2019, when the Health Protection Advisory Group met, and we can see from the first page that Public Health Wales were represented by Andrew Jones.
You sent your apologies for that meeting. We can see that halfway down the page. But no doubt you will have been filled in by – what took place during the course of the meeting and any recommendations that came out of it?
Dr Andrew Goodall: Yes, I was on annual leave. Andrew Jones is my deputy.
Counsel Inquiry: Thank you.
Can we go to page 4, please, of these meeting notes, and look at paragraph 5.2. Thank you.
We can see that the:
“CMO acknowledged [that] there were significant questions around the preparedness of NHS Wales to deal with a similar situation and to be able to manage an infected case at one of our acute hospitals for at least 24hrs. It was agreed that whilst a key work stream of strengthening the National Health Protection Service would look at an all-Wales system for dealing with high consequence infections more urgent action was necessary to provide reassurance.”
To what does this relate, please?
Dr Andrew Goodall: So this relates to discussions that were taking place at the time about the development of a high-consequence infectious diseases unit in Wales.
Counsel Inquiry: Yes.
Dr Andrew Goodall: At that time, it was necessary for any patient that had a high-consequence infectious disease to be transferred to a designated unit in England.
Counsel Inquiry: Yes. Right. Well, if we look at the bottom of this paragraph, we can see that action 23 was for the:
“CMO to write to health boards, [Public Health Wales] and WAST requesting their plan/pathway for dealing with a high consequence infectious disease (deadline for [which was] March 2020).”
Do you know whether or not that was done?
Dr Andrew Goodall: So in January 2020, as it became clear to us in Public Health Wales the novel coronavirus represented a very serious threat, we as an organisation entered into discussions with Welsh Government and – with one of our local health boards, to discuss how we could establish very quickly a high-consequence infectious disease unit at that hospital, in advance of and in readiness for potential patients if novel coronavirus came to Wales.
Counsel Inquiry: We can take that down now, please.
I would like to look at the Emergency Planning and Business Continuity Group and look at the terms of reference for this group which are at INQ000089648.
Thank you.
We can see that’s the front page there. These are the terms of reference.
If we turn to page 2, please, we can see in the top third of the page that again you are the sponsoring executive, as the executive director of public health services, and medical director.
Can you tell us when this group was established and what the purpose was for the group being brought into force?
Dr Andrew Goodall: So the group was established in August 2018. The story behind it is we had conducted a review of our business continuity arrangements in 2016, and that review had recommended that we should bring together our business continuity and emergency planning arrangements under the leadership of a single executive. They were at that time under different executives within Public Health Wales.
It also recommended that we should establish the role of the business continuity – sorry, the executive – the emergency planning and business continuity lead, the manager that I have already referred to.
Counsel Inquiry: Yes.
Dr Andrew Goodall: So all of that was accepted in 2017, and in 2017 we brought – started to bring these entities together, and that was finally completed and formalised in the first half of 2018.
Counsel Inquiry: If we look at the bottom part of this page, we can see that under the heading “Updates and amendments” that there is a blank table. Has this document, these terms of reference, ever been updated or amended?
Dr Andrew Goodall: I don’t know the answer to that question to the current time.
Counsel Inquiry: All right. Well, if we need to establish the answer for that, then we will formally ask.
Is it right that the Emergency Planning and Business Continuity Team was steered by the local resilience forum?
Dr Andrew Goodall: The Emergency Planning and Business Continuity Team effectively provided the operational leadership for the implementation of the emergency preparedness planning and response arrangements of Public Health Wales, and that necessitated engagement with a wide range of partners, Welsh Government, local government, the health boards, the local resilience fora.
Counsel Inquiry: Well, let’s look at the Emergency Planning and Business Continuity Work Plan, please, 2018 to 2020, which we can see at INQ000183523. Was this document the work plan for the group?
Dr Andrew Goodall: It was.
Counsel Inquiry: You sponsored this document as well, didn’t you?
Dr Andrew Goodall: I did.
Counsel Inquiry: Which was approved in July of 2019.
Could we look at page 2, please. Thank you.
We can see at the top that:
“[The] document outlines the Emergency Planning and Business Continuity actions for [the time period]. The actions address the legal requirements on Public Health Wales in its role as a Category 1 responder …”
Can we go to page 9, please.
We can see it that this sets out the emergency planning activity under the integrated emergency management system, and if we could just scroll through the next few pages we can see that there are the six phases that we’ve seen before.
Thank you, if we can carry on.
Ending with – next page, please – response and recovery.
There are no references to pandemic or influenza in this document, although there are references to bomb threats and Brexit health and other such matters. Do you agree with that?
Dr Andrew Goodall: I do agree with that.
Counsel Inquiry: Why were references to the threats or hazards of pandemic influenza and matters of that nature not contained within this document?
Dr Andrew Goodall: So the reason why Brexit was included, because it was a live issue at the time. Pandemic influenza was not included because we were having – those were set out in the other documents, that no doubt we will come to, the documents that have already been referred to, and that this therefore took a strategic approach to how we discharged our responsibilities under the Civil Contingencies Act in respect of any incident, outbreak or emergency that might take place. But it didn’t explicitly refer to the development of pandemic influenza planning.
Counsel Inquiry: Were you aware when you sponsored this document that the National Risk Assessment had assessed the hazard of pandemic influenza as being at the first tier, so it created the most serious threat?
Dr Andrew Goodall: Yes, we did.
Counsel Inquiry: So do you still say that it wasn’t necessary or appropriate for it to be mentioned in this work plan for emergency planning?
Dr Andrew Goodall: As I say, we recognised that pandemic influenza was at the top of the National Risk Assessment and we were fully engaged throughout the period of Module 1 in direct discussions with Welsh Government and with our local resilience fora to prepare and respond to influenza pandemic.
Counsel Inquiry: But that’s not really an answer to the question. Didn’t it deserve a mention in this document?
Dr Andrew Goodall: In hindsight, yes, I can see that it could, but at the time, having just established this group, we didn’t include it.
Counsel Inquiry: Does the fact that it’s not included demonstrate that pandemic influenza was not in the forefront of the mind of Public Health Wales and other organisations who were involved in the creation of this document?
Dr Andrew Goodall: No, I don’t agree with that. As I prefaced my previous answer, Public Health Wales has had a full and active involvement in support of and advising Welsh Government and partners in the development of our pandemic influenza plans.
Counsel Inquiry: Public Health Wales did sit on the Wales Pandemic Flu Preparedness Group, didn’t it?
Dr Andrew Goodall: It did.
Counsel Inquiry: I’d like to look now, please, at a set of minutes from the meeting of that group in January of 2018.
We have them at INQ000187219. Thank you.
Now, we can see who was present. David Goulding, who was the Welsh Government health emergency planning adviser, and other members of the Welsh Government, and then we know that Public Health Wales was present, although the name of the person attending has been redacted. So that wasn’t you on this occasion?
Dr Andrew Goodall: No, it wasn’t, but I do know who it was.
Counsel Inquiry: All right. Well, perhaps that doesn’t matter, and if it does we’ll come back to it.
Could we have a look, please, at the second paragraph, which is I think on page 2. Thank you. Here we see under the heading “UK Pandemic Flu Review and Work Plan”:
“DG discussed the PFRB High Level Work Plan, advising that the Review Board had agreed to extend the time period into a second year to address ongoing deliverables. [He] asked if there were any questions regarding the Work Plan, none were asked and added that the next UK Pandemic Flu Readiness Board would meet at the end of February. WP alluded to the difficult timescales for some areas being set centrally.
“The meeting discussed the importance of operational delivery, through the UK review some key pandemic influenza strategic policies and guidance are updated notably the UK Pandemic Influenza Framework 2011 and the Cabinet Office Pandemic Influenza Guidance to LRFs.”
Now, is it right that three of the four LRFs were not in attendance at this meeting?
Dr Andrew Goodall: You would have to re-show the first page for me to be certain.
Counsel Inquiry: All right. Can we go back to that, please. At the bottom paragraph here we can see:
“It was noted with disappointment that three of the four LRF Chairs” –
Dr Andrew Goodall: Yes.
Counsel Inquiry: – “were not in attendance. WP confirmed that the LRF chairs had been invited and that no apologies had been received from them. Reference was made to LRF engagement with being taken forward by the DCLG in England and the need for Welsh Government to also engage with the LRFs in Wales. DG emphasised the importance of having the LRF chairs on the group and asked that this be re-enforced with them.”
Does this chime with any concern that you had about the engagement of LRFs in this particular group?
Dr Andrew Goodall: Until I saw these minutes recently, I had not remembered that only one of the four LRFs had been in attendance. My memory of our LRFs is that they were active and full participants in pandemic flu preparedness, and I’ve noted which health board was in attendance. So I share this disappointment of the chair, and fully agree with his sentiment that they should be reminded of the importance of attending.
Counsel Inquiry: But was this a common theme?
Dr Andrew Goodall: No.
Counsel Inquiry: Was this a problem, that the LRFs were not engaged in this particular group?
Dr Andrew Goodall: No, as I said at the preface to the last answer, my experience was that the LRFs were active participants with us in all areas of emergency planning and response, including pandemic flu.
Counsel Inquiry: Is your recollection at the time that these meetings were taking place – and these minutes, I remind us, were at January of 2018 – that the Wales Pandemic Flu Preparedness Group was an effective group?
Dr Andrew Goodall: The … so I was aware that there were a range of workstreams which had made limited progress, as has been discussed already.
Counsel Inquiry: All right. Well, I’d like to look, please, again at page 2 and at paragraph 3, and the first paragraph there:
“WP advised that it was the perception at a UK level that Wales and other devolved governments are lagging slightly behind England in some areas such as legislation and health and social care surge planning due to a lack of resource.”
Were you aware of that at this time?
Dr Andrew Goodall: I was, and I recognise those issues.
Counsel Inquiry: All right. What was done about it?
Dr Andrew Goodall: So, as I understand it, Welsh Government were undertaking work on healthcare surge planning, particularly in the area of critical care. I wasn’t familiar with the detail of the progress with the social care surge planning.
Counsel Inquiry: All right. We can take that down, please.
The Wales Health and Social Care Influenza Pandemic Preparedness and Response Guidance we see at INQ000089573.
This was issued, as we see, by the Welsh Government Department of Social Services, Health Emergency Preparedness Unit in February of 2014, and this was really the Welsh response to the United Kingdom 2011 guidance, wasn’t it?
Dr Andrew Goodall: It was.
Counsel Inquiry: Yes. You will be familiar with this document, Dr Sandifer?
Dr Andrew Goodall: Yes.
Counsel Inquiry: Yes, and you can confirm then, without us having to go into the detail of it, that in general terms it relied upon the planning assumptions that had been established in the UK 2011 document?
Dr Andrew Goodall: Yes.
Counsel Inquiry: All right.
This guidance deals with stockpiles of a range of consumable products, including eyewear, aprons, gowns and gloves. We don’t see that level of detail in the UK document. Did Public Health Wales have any involvement in providing the additional guidance in relation to those particular areas of stockpile?
Dr Andrew Goodall: So the Welsh Government led on countermeasures stockpiling, including PPE. Our infection prevention control lead did occasionally provide advice to Welsh Government if any specific questions were raised, but we had no other direct involvement.
Counsel Inquiry: Could we go to page 13 of this document, please. Thank you.
Now, we can see here the co-ordination arrangements for major infectious disease emergencies in Wales. If we familiarise ourselves with this, we’ve got the National Security Council at the top, SAGE to the right. Then, going from left to right on the second level, the Department of Health organisations and the devolved administration health departments. In the middle we’ve got the Wales Civil Contingencies Committee and the DH&SS Health Response Team, and to the right the strategic co-ordination groups.
Then on the third tier, left to right, we have the health boards, the NHS trusts and there, in the right-hand corner at the bottom, Public Health Wales.
Now, is that co-ordination arrangement familiar to you?
Dr Andrew Goodall: It is.
Counsel Inquiry: There would appear from this chart to be no direct contact or line of contact between Public Health Wales and, for instance, the SAGE group that we see at the top right-hand corner. Do you think there should have been?
Dr Andrew Goodall: So, as I said earlier, no, there was no direct connection between us and SAGE. We expected that Welsh Government would be invited to join SAGE at both ministerial and official level, and if it was thought appropriate by Welsh Government for Public Health Wales representation in support of their minister or officials, then we would have been pleased to provide that.
Counsel Inquiry: All right.
Could we go to page 31, please.
Now, in relation to community care, we can see that the guidance here is that:
“As demand for hospital care increases, patients discharged home may require a greater level of care than they would do normally. Social and community care services may face particular challenges that include …”
There are a series of bullet points there.
Just moving down below the bullet points:
“Care of individuals in the community therefore presents a diverse and complex challenge at a time when staffing capacities are likely to be reduced. Close working relationships across health and social care organisations, the independent sector and voluntary groups will be essential to sustaining services during a pandemic.”
Do you agree, Dr Sandifer, that this plan should have included more guidance around when someone should be discharged from hospital and what should happen on discharge back into the community, for example guidance on sending tested or untested patients to care homes or back into the community?
Dr Andrew Goodall: Obviously that became an important issue during the coronavirus pandemic, and I can see that that could have been helpful to the health boards, and incidentally it was the health boards and the local government overseeing social care services that would have been the principal beneficiaries of that guidance.
Counsel Inquiry: All right.
Do you agree that there is also a failure or a gap in this guidance to include advice in terms of when lockdowns or social distancing measures of any description could or should have been implemented?
Dr Andrew Goodall: Well, on lockdowns, I think it’s fair to say from my own professional experience I hadn’t envisaged circumstances where we would have locked down a whole society or, indeed, a whole country in the way that we did in March 2020. Of course self-isolation of individuals or perhaps a family unit, or quarantine of a small defined population, are established principles in public health infectious disease control. But lockdowns took us into completely unchartered territory.
Counsel Inquiry: But there’s nothing in this document about any social distancing measures of any severity, from mixing with people within your community and that being restricted to the other end of the spectrum, which is lockdown; is that a mistake?
Dr Andrew Goodall: I would expect our health boards, working through their local resilience fora, to be familiar with the basic tenets of social distancing as a regular or a normal practice in reducing community transmission. So at the – if you like, that end of the spectrum, I’m not sure that that needed formal guidance. But of course lockdowns I don’t think were anticipated in the way that they were implemented, and that is the reason why they don’t appear.
Counsel Inquiry: All right.
Well, before we turn away from plans and guidance, I’d just like to look at two more documents, please.
The first is at INQ000089572, and this is the Welsh Government’s Wales Framework for Managing Major Infectious Disease Emergencies.
I know that the Inquiry has already looked at this document. It’s dated October of 2014. We can see at the bottom left-hand corner it’s issued by the Health Resilience Branch of Welsh Government.
I would just like to look at paragraph 1.1 on page 5, please, and 1.2 as well, if we could zoom in, please, on those two paragraphs.
We know that:
“This Framework sets out generic arrangements for the management of major infectious disease emergencies by health services in Wales and should be considered in the context of the principles set out in …”
Then there’s four more pieces of documentation and guidance: the NHS Wales Emergency Planning Guidance, the Cabinet Office statutory guidance Emergency Preparedness, and the non-statutory guidance Emergency Response and Recovery, and the Pan-Wales Response Plan.
“The Framework is supported by the following guidance …”
We’ve then got five more pieces of guidance:
“The Communicable Disease Outbreak Plan for Wales …
“The UK National Framework for responding to an influenza pandemic …”
Which we’ve already mentioned.
“Guidelines for Smallpox Response …
“Wales Health and Social Care Influenza Pandemic Preparedness & Response Guidance …”
Which we’ve just looked at.
And:
“NHS Wales Guidance Mass Casualties Incidents – A Framework for Planning.”
This was a complicated business, wasn’t it?
Dr Andrew Goodall: It was.
Counsel Inquiry: Did you, in your role at the time, find it unhelpful that there were so many different pieces of guidance and planning documentation that would need to be assessed and considered in the outbreak of a pandemic?
Dr Andrew Goodall: I was very conscious that you had to have a good understanding of the range of organisations and guidance to be able to navigate your way through this.
Counsel Inquiry: Right. Far better, do you agree, Dr Sandifer, to have a slimmed down, simplified set of guidance and plans for everybody to be able to understand and follow?
Dr Andrew Goodall: There’s absolutely no doubt that the principle of consolidating and simplification is a good idea, would have been helpful, but I think it’s just worth recognising the context of a couple of these plans.
The Communicable Disease Outbreak Plan for Wales, which we haven’t discussed yet, that was really a plan for responding to local outbreaks, whilst this framework was for responding to infectious disease threats that might affect the whole of Wales.
So I think it’s important to recognise that there was some need for distinguishing between a plan to deal with something at a local level, between something at a national level, but the general premise of simplification would have been helpful.
Counsel Inquiry: All right, thank you.
Well, let’s look, please, finally, at the Communicable Disease Outbreak Plan for Wales, which is at INQ000089575. Thank you.
Can we go to page 2, please.
Now, we can see under the preface, written in April of 2014:
“In recent years, there have been multiple plans in Wales for the investigation and control of communicable disease. All these have contained very similar guidance. Whilst it has been recognised that each individual plan was robust and fit for purpose, the presence of several plans for use in outbreaks has caused confusion as to which plan should be followed. Therefore, at the request of the Welsh Government, a multi-agency working group was convened in 2008 to draw the plans together into one generic template.”
So just pausing there, this is a reaction in April of 2014 to multiple plans for the investigation and control of communicable diseases, so this was an effort undertaken in 2008, to simplify things, but, as we’ve just seen, in fact, although this one response deals with this particular area, when you look more widely there were still multiple pieces of guidance and planning documentation that was still in existence?
Dr Andrew Goodall: That’s correct.
Counsel Inquiry: Can we move down, please, to look at the full page. Thank you. If we can go over to – oh, in fact, before we do that, can we just highlight what we can see in bold in the middle of the page, please. Because when we look at what was used to create this plan, we can see that it’s an amalgamation of a major outbreak of food poisoning plan, an emergency framework for health-related incidents and outbreaks in Wales and Hertfordshire from contaminated drinking water, and then, finally, the model plan for the management of communicable disease outbreaks in Wales.
So, so far as this Inquiry is concerned, that is the model plan upon which this document was able to draw?
Dr Andrew Goodall: Yeah, if I could just clarify something about the development of this plan. We had a series of plans – highlighted in bold here – in the early noughties, which we recognised caused confusion, as the first paragraph states. The work began in 2008. The first version of the Wales Communicable Disease Outbreak Plan was actually published in 2011, and then we kept it under review and this plan reflected an updating of the 2011 communicable disease outbreak plan in April 2014.
Counsel Inquiry: All right. Well, I want to look further back, please, because the Management of Communicable Disease Outbreaks plan upon which this was based, taking into account what you’ve just said about there being an interim plan in 2011, was first written in 1995; is that right?
Dr Andrew Goodall: As I understand it, yes.
Counsel Inquiry: And not updated until this plan was brought into force, although we can see that there was a draft update in 2007.
Dr Andrew Goodall: So there was a draft update in 2007, and then that plan, together with the other two plans, consolidated into the 2011 plan that I’ve just referred to.
Counsel Inquiry: Yes.
Why was the Management of Communicable Disease Outbreaks plan not updated between 1995 and 2011?
Dr Andrew Goodall: I don’t know the answer to that. It pre-dated my time in office.
Counsel Inquiry: Do you think that by 2011 the 1995 plan was massively out of date?
Dr Andrew Goodall: Well, the 1995 plan had been updated, but it was in a draft form –
Counsel Inquiry: Well, according to – I’m so sorry, Dr Sandifer, but according to this note, although a draft update was in force in 2007, from what you’ve told us, that wasn’t formalised until 2011.
Dr Andrew Goodall: That’s right.
Counsel Inquiry: All right.
Dr Andrew Goodall: But I would anticipate that our communicable disease specialists would have been working to the most updated plan, even if it was still in draft format.
Counsel Inquiry: But why wasn’t it updated between 1995 and the draft update of 2007?
Dr Andrew Goodall: I don’t know the answer to that question.
Counsel Inquiry: Does that concern you?
Dr Andrew Goodall: It is a very long time, and I would have expected our plans to have been reviewed and updated in a period of 12 years, at least once or twice.
Counsel Inquiry: Yes. So does it concern you that it wasn’t, according to this note?
Dr Andrew Goodall: If I – yes, I mean, it’s a concern that 12 years elapsed between updating of a plan.
Counsel Inquiry: Again, I have to ask: does the fact that the communicable diseases outbreaks plan was in abeyance, I’m going to suggest, demonstrate that this was not a subject at the forefront of those who should have been thinking and planning about it?
Dr Andrew Goodall: I don’t think that’s a fair characterisation of the people who were responsible for discharging communicable disease control during that period. It is a fact, and I’m not disputing that, for a period of 12 years it would appear that this plan was not updated, and I don’t have information to explain that.
Counsel Inquiry: All right. Well, I’d like to go back, please, just for a moment to the emergency response plan that we’ve looked at briefly, the Public Health Wales Emergency Response Plan, which is at INQ000089558, because I’d just like to for a moment concentrate on what level of consideration was given by Public Health Wales in this emergency response plan to vulnerable people.
We can see that consideration at page 25:
“Public Health Wales is required to give special consideration to those who are made vulnerable as a result of the emergency or who are less able to help themselves in the circumstances of an emergency.”
And we see at 14.5:
“Those who are vulnerable will vary depending on the nature of the emergency. For planning purposes the Cabinet Office Guidance … states that there are broadly 3 categories that need to be considered …”
Then we have those with mobility problems, those with mental health or learning difficulties, and dependents such as children.
So it rather looks as if Public Health Wales were taking their lead as to who would qualify to be described as vulnerable from the Cabinet Office guidance at chapter 5 of the emergency planning – Revision to Emergency Preparedness document?
Dr Andrew Goodall: Yes, I would accept that.
Counsel Inquiry: Do you think that that was an extensive enough description of who should be categorised and considered as vulnerable?
Dr Andrew Goodall: Well, in hindsight and reflecting from today, no, I don’t.
Counsel Inquiry: Because it doesn’t contain any mention of the elderly or those with comorbidities or those suffering from health inequalities, does it?
Dr Andrew Goodall: No, it doesn’t explicitly refer to those, but the way I would expect this section of the plan to be implemented is that the – in the circumstances of an emergency, a risk assessment would be undertaken. The populations most at risk in the course of that incident would be identified, and the responders would pay due attention to those. But – and that could be a very, very long list, but this does reflect what the chapter 5 says in the guidance.
Counsel Inquiry: Has that narrow definition now been expanded?
Dr Andrew Goodall: So Public Health Wales recognises that it needs to take a more, to quote Alexander and Mann, “people-centred approach” to its emergency response planning, and the current guidance plan that was recently published takes us some way toward that but acknowledges that there is still further work to be done to address that issue.
Counsel Inquiry: Is that plan that you’ve just mentioned, the updated plan, an update of this?
Dr Andrew Goodall: It is.
Counsel Inquiry: What’s the date of it, please?
Dr Andrew Goodall: May of 2023.
Counsel Inquiry: So the current position is that, as you’ve just told us, Dr Sandifer, the definition has been broadened but on reflection now it needs to be broadened even further?
Dr Andrew Goodall: So it has been broadened and in very particular way to take account of inequalities, recognising the particular impact inequalities had during the coronavirus pandemic. But it’s my view that that plan represents a stage in a process that still needs further development, and I understand that my successor has had conversations with his strategic partners to signal the need for us to continue that work.
Counsel Inquiry: Do you know when that will be completed?
Dr Andrew Goodall: I don’t know when that work will be completed. The plan has just been approved and I would envisage that Public Health Wales will attend to that now.
Counsel Inquiry: Are you able to help us with the detail of how that current definition still requires to be extended?
Dr Andrew Goodall: Well, this definition is still within the guidance. These groups are still relevant categories –
Counsel Inquiry: Yes.
Dr Andrew Goodall: – in any future plan. I would envisage that the plan as it develops might move away from the expression of “vulnerable persons”, although that is generally recognised within the EPRR community, and set out more broadly the wider range of vulnerabilities in the population that the plan should consider.
Counsel Inquiry: So I’m going to press you on this. What isn’t contained in the current 2023 guidance that needs to be contained within it?
Dr Andrew Goodall: Well, the guidance does refer to inequalities, but I think it could go further and expand on what that means in terms of different population groups, minority ethnic groups, for example, who were particularly vulnerable during the coronavirus pandemic.
Counsel Inquiry: For whatever reason that level of detail has not yet found its way into the 2023 guidance?
Dr Andrew Goodall: That, I think, is simply a reflection of the scale of work that Public Health Wales is still engaged in, in the transition of Covid-19 into an endemic and the recovery work associated with that.
Ms Blackwell: All right. Thank you very much.
Those are all my questions for Dr Sandifer.
I understand, my Lady, that you’ve provisionally provided permission for Bereaved Families for Justice Cymru to have five minutes of questions on particular topics.
Lady Hallett: I have, thank you.
Questions From Ms Shepherd
Ms Shepherd: Thank you, my Lady.
Dr Sandifer, I ask questions on behalf of Covid-19 Bereaved Families for Justice Cymru.
I want to look at an exhibit in your witness statement. If we could have up on the screen, please, INQ000089594.
So this is the report to inform policy on airborne isolation rooms in major acute hospitals, and it’s the Report of the Airborne Isolation Rooms Review Working Group on behalf of Welsh Government.
If we have a look at the date, it’s 18 October 2017, and we can see the purpose and summary of the document at the bottom.
If we look now, please, at page 2, in the introduction, and it’s the top paragraph, it says here:
“Since 2006 NHS Wales Shared Services Partnership – Specialist Estates Services … have surveyed and produced an annual report on all airborne isolation rooms in major hospitals across Wales. Every year the reports have concluded that many of these airborne isolation rooms are inadequate for the purpose intended when assessed against current best practice.”
Then the rest of that introduction just outlines why there needs to be a working group to look at this.
If we then look, please, at page 3, next, these are the recommendations and this is an indicative list of the organisms requiring airborne isolation facilities. Subparagraph (f): “SARS like infections and MERS CoV”.
If we have a little look down at the bottom of the page there are some recommendations. Recommendation 2:
“Every hospital in Wales with a 24-hour Emergency Unit must have at least one Negative Pressure Suite located within that Emergency Unit.”
Then the recommendation below:
“Every Health Board in Wales must have at least one Negative Pressure Suite able to accommodate a case requiring respiratory isolation …”
If we have a look now, please, at page 13 of this document –
Lady Hallett: Ms Shepherd, just before you go on, can you alert me to which is the question I have given permission for you to ask.
Ms Shepherd: Yes, my Lady, you gave me permission to ask why there hadn’t been an update to the airborne isolation facilities in accordance with this document.
Lady Hallett: Sorry, I must have lost it. Anyway, okay.
Ms Shepherd: If we have a look at page 13, the very bottom bullet point of this page, it says:
“Current building structures do not support safe management of patients with infectious diseases, pose significant threats to the capacity of the hospitals following admission even of suspected cases, pose a threat to the well-being of healthcare staff …”
So that was the case as at 2017. Ms Blackwell KC put to you earlier some meeting minutes from 2019 when the CMO, Sir Frank Atherton, had raised the issue with ability to deal with HCID infection. Was that still the case as of January 2020?
Dr Andrew Goodall: Yes, I expect it was. I certainly raised it as a concern, an ongoing concern, in July of 2019 with the Chief Medical Officer. I fully recognise this report and I fully agree with the content of this report.
I should state here for clarity: the responsibility for ensuring that there are safe isolation facilities on the healthcare estate rests with the health boards in Wales.
Ms Shepherd: Could we have a look, finally, please, in this document, at page 14, in the very top bullet point:
“None of the Health Boards are designed to deal with such threats and there is no hospital in Wales currently that has a facility to manage emerging infectious threats at an optimal level.”
So since 2006 this has been raised, it was raised in this document in 2017, and it was raised again by the CMO Frank Atherton in 2019, we get to January 2020 and still nothing has been done to address this; do you agree?
Dr Andrew Goodall: I agree that this was a significant area that, yes, had not yet been adequately dealt with over a very long period of time.
Ms Shepherd: Does that reflect that there was a lack of urgency in Wales to address this issue and lessons were not learned?
Dr Andrew Goodall: I can’t speculate on the precise reasons for that. As I say, Public Health Wales has flagged this as an issue over the years, but the issue clearly was not fully addressed by the time Covid-19 came along.
Ms Shepherd: Does that reflect a lack of urgency to deal with infection control generally in hospitals?
Dr Andrew Goodall: Again, our health boards, who have responsibility for the hospitals in Wales, also have a responsibility for healthcare-associated infections and antimicrobial resistance, and again that was a journey that they were still on. Public Health Wales had worked with them over the years to address the performance and generally progress had been made, some had made better progress, but we were not yet where I would have liked by the time we reached the end of 2019.
Ms Shepherd: Thank you, my Lady.
Lady Hallett: Thank you, Ms Shepherd, I did find the question in the end. Thank you.
Ms Blackwell.
Ms Blackwell: Thank you, that concludes Dr Sandifer’s evidence.
The Witness: Thank you.
(The witness withdrew)
Lady Hallett: I think the suggestion is I should take a shortened lunch break because we’ve got quite a heavy afternoon.
Ms Blackwell: Yes, my Lady, would you consider perhaps sitting again at quarter to? Thank you very much.
Lady Hallett: Very well, quarter to. Thank you.
(12.58 pm)
(The short adjournment)
(1.45 pm)
Lady Hallett: Ms Blackwell.
Ms Blackwell: Good afternoon, my Lady. May I please call Vaughan Gething.
Mr Vaughan Gething
MR VAUGHAN GETHING (affirmed).
Questions From Counsel to the Inquiry
Ms Blackwell: Thank you, Mr Gething, and thank you for the assistance that you’ve so far provided to the Inquiry. Thank you for coming to give evidence today.
Your witness statement is at INQ000187304. If we go to page 20, please, we can see that it was signed on 19 April of this year, and can you confirm, please, that it’s true to the best of your knowledge and belief?
Mr Vaughan Gething: Indeed, yes.
Counsel Inquiry: Thank you very much. We can take that down.
Now, dealing with your professional background, so far as it’s relevant to this Inquiry, in 2003 you were president of the Wales TUC Cymru, you were also a partner at the law firm Thompsons LLP. In May of 2011 you became a member of the Senedd for Cardiff South and Penarth. In June of 2013 you were appointed as Deputy Minister for Tackling Poverty, and in September 2014 as Deputy Minister for Health.
By May of 2016 you had become Cabinet Secretary for Health, Well-being and Sport, and you maintained that position when the name of that portfolio was changed in 2018 to Minister for Health and Social Services, and from May of 2021 you have been Minister for the Economy; is that right?
Mr Vaughan Gething: That’s correct.
Counsel Inquiry: Thank you.
So you held roles within the Ministry of Health in one way or another since September of 2014, but before October of 2016 is it right that you had not been presented with the fact that a pandemic was a significant health risk to Wales?
Mr Vaughan Gething: Well, I understood that if a pandemic happened it would be – it wasn’t, as it were, brought to my direct attention that it was something that I needed to be particularly prepared for. I had other priorities, not this.
Counsel Inquiry: So when did you become aware that a pandemic was a priority for Wales?
Mr Vaughan Gething: In the run-up to Exercise Cygnus with the briefing, I can’t remember which officially it was, but described the fact that there was a request for an exercise and for my attendance and participation, which obviously I undertook.
Counsel Inquiry: When you became Deputy Minister for Health, did you understand at that stage that pandemic influenza in particular was a Tier 1 risk for the United Kingdom?
Mr Vaughan Gething: No, it wasn’t the focus of my role as Deputy Minister for Health.
Counsel Inquiry: Well, did you understand that it was a Tier 1 risk? It might not have been a focus, but did you know at that time –
Mr Vaughan Gething: No, no, because pandemic preparedness would have rested with the Cabinet Minister for Health at the time. My role was very much on NHS performance and the link with social care in as far as it affected delayed transfers of care.
Counsel Inquiry: So until you became Minister, Cabinet Minister, you had no knowledge that pandemic influenza was a Tier 1 hazard?
Mr Vaughan Gething: No, not in the way it’s described now, no.
Counsel Inquiry: Becoming Minister in May of 2016, did it take five months for you to become aware of the pandemic threat?
Mr Vaughan Gething: So when I became the Minister, the Cabinet Minister, I received a briefing which did mention pandemic preparedness but there wasn’t an in-depth briefing, and it was in the – as I say, in the run-up to Operation Cygnus, the Cygnus exercise, that I was much better informed about the preparation for a pandemic and, indeed, the potential scale of it, and its relationship in the UK-wide risk register.
Counsel Inquiry: So before the briefing in October of 2016, what did you know? At the time that you became Cabinet Minister, did you understand that pandemic influenza was a Tier 1 risk?
Mr Vaughan Gething: Not in those exact terms, I think that would be wrong. I knew that we had pandemic preparedness, and I’d seen it and read my initial briefing, obviously, but not in the way it’s now described in the Tier 1 risk register. It would be wrong for me to try to tell you that I understood that it was in the Tier 1 risk register. That was definitely in the run-up to and the briefing for Cygnus.
Counsel Inquiry: So what did you know of it in May 2016, what did you know of pandemic influenza?
Mr Vaughan Gething: I knew that it was a potential risk. I’d obviously lived in Wales and so was aware that swine flu had been something that the government had had to deal with, so it was a much – much more general than the specific awareness of it being a Tier 1 risk in the UK-wide risk register.
Counsel Inquiry: As newly appointed Cabinet Secretary for Health, Well-being and Sport, didn’t you think that it was your business to understand what was the most pressing health risk to Wales?
Mr Vaughan Gething: In the briefing that I had, it described the fact there was work ongoing about pandemic preparedness, it described the fact that this was something the department was responsible for at the time of my appointment. In terms of the most pressing risk, the risk register I think describes if these things come to pass these are the biggest risks that can happen. My job, in terms of being the Health Secretary for all the risks I had in front of me, were the very standard things in a politically contested environment.
Counsel Inquiry: Can we take it that if you didn’t appreciate it was a Tier 1 risk, you didn’t read the National Risk Register or the assessment?
Mr Vaughan Gething: No, I did not read the National Risk Register.
Counsel Inquiry: Nor did you read any of the guidance and documents that we’ve been through during the course of this Inquiry so far? I’m going to describe it as a myriad of guidance and plans that were in force at the time dealing with civil emergencies in general and pandemic influenza in particular.
Mr Vaughan Gething: No. I’m aware you have gone through a range of plans with previous witnesses and I did not read those on my entry into the post.
Counsel Inquiry: When did you read them?
Mr Vaughan Gething: I’ve read some of them for the first time in preparing for this Inquiry, because as a minister, for some of those documents, they’re not actually read – for the minister to read, it’s about how the system, the overall system is prepared. I did obviously receive briefings on our pandemic preparedness from Cygnus onwards at various points in time, and they’re included in the documents before the Inquiry.
Counsel Inquiry: All right.
Lady Hallett: Just pausing there, sorry, Mr Gething, like me you speak very quickly and we have a struggling stenographer.
Mr Vaughan Gething: Okay.
Lady Hallett: So I have to train myself to try to slow down.
Mr Vaughan Gething: I will try to speak slightly slower.
Ms Blackwell: Thank you.
The Inquiry has heard much about the United Kingdom influenza preparedness strategy of 2011, and you will now be familiar with that document, Mr Gething.
Mr Vaughan Gething: Yes, I see it.
Counsel Inquiry: Yes. It doesn’t feature at all in your witness statement. When did you first read it?
Mr Vaughan Gething: I read it in advance – I read it and looked over it in advance of preparing for this Inquiry.
Counsel Inquiry: So whilst you were in post as Cabinet Office Minister for Health and Social Services, you hadn’t read the United Kingdom Influenza Pandemic Preparedness Strategy?
Mr Vaughan Gething: No, I’d received briefings on the strategy in advance of Cygnus and indeed briefings on our own strategies in Wales to try to implement those.
Counsel Inquiry: Were you aware during your time in office that the Welsh Government had implemented the strategy into their own planning?
Mr Vaughan Gething: Yeah, that was my understanding, yes.
Counsel Inquiry: All right. Does that mean that you were aware, then, of the Wales Framework for Managing Major Infectious Disease Emergencies?
Mr Vaughan Gething: I was aware of it insofar as I was briefed on it, but, as I say, that document isn’t written for ministers to run through and to read through. And I think it’s part of the point where you sit as a minister within the system and the choices you’re required to make. If I chose – if I read all of those documents and others within my brief, then I wouldn’t get to do anything else. It’s a choice about how ministers’ time is used.
Counsel Inquiry: There is no mention of that document in your witness statement. Can we take it from that that, although you might have been aware of it, you didn’t read it whilst you were in office?
Mr Vaughan Gething: That’s correct.
Counsel Inquiry: Were you aware of the planning assumptions that form the basis of both of those documents, the UK-wide and the Wales document?
Mr Vaughan Gething: Yeah, and that forms part of the briefing that went into Operation Cygnus and so it set out the point about the risk register, it set out the planning assumptions on an influenza pandemic being the most likely of the pandemics that could come. So those planning assumptions were part of that, and obviously they were part of how Cygnus was run as an exercise.
Counsel Inquiry: Did you ever question whether those planning assumptions were tolerable or whether they might be mitigated?
Mr Vaughan Gething: I didn’t question the assumption that an influenza pandemic was the most likely of the pandemic risks, and in terms of what was tolerable I think that comes into some of the things we went through in the Cygnus and some of the follow-on work, and then obviously we had to deal with those as very live issues during the Covid pandemic.
Counsel Inquiry: When you were in office, were you aware of the Wales Health and Social Care Influenza Pandemic Preparedness and Response Guidance of 2014?
Mr Vaughan Gething: I wouldn’t say I was aware of the detail of it. Again, I read that document, and looked over it more fully in preparation for this Inquiry, but I received briefings on the document and on the requirements in it around Cygnus and afterwards, and you’ll see it’s mentioned in a number of the documents that then come to me in the briefings I received from officials.
Counsel Inquiry: So did you read that document whilst you were in office?
Mr Vaughan Gething: No, I didn’t read it in detail, because, as I say, I’d received a briefing on what’s generally required in the documents and how that then would affect the choices you might have to make as a minister.
Counsel Inquiry: Were you aware as part of your briefing to that document that paragraph 1.3 says that it will not be possible to stop the spread of the pandemic influenza virus in the country of origin or in the UK as it will spread too rapidly and too widely?
Mr Vaughan Gething: I’m aware that’s the planning assumption and, as I say, in the run-up to Cygnus the assumption of that exercise was that flu was already here and the challenge of dealing with an influenza pandemic, again the assumptions were it would already be here in numbers and it would be spreading. So that challenge was there. But I don’t want to – in terms of the specific paragraph and had I read that before, that’s not correct, but I was aware of the assumption, as you put it earlier, in planning terms.
Counsel Inquiry: Do you agree with the evidence that the Inquiry has heard from other witnesses that that was a flawed doctrine, that really there should have been consideration given to preventing the spread rather than accepting that influenza would spread and that mitigation of how to deal with the fallout from that was all that the plan related to?
Mr Vaughan Gething: Yes, I’ve heard the witness evidence from a number of people that it was a flaw to assume that it would be an influenza-type pandemic and it would already be here. There are, of course, questions you will come in to, I’m sure, about how far you could either prevent or contain something like that.
Counsel Inquiry: If you didn’t read these documents themselves and only relied upon the briefings you were given, would you have been aware of the absence in them of any guidance about the scaling up of contact tracing, or moving patients or quarantining or indeed lockdown?
Mr Vaughan Gething: Well, there’s a number of points there. So the guidance on a scaling up activity or moving patients, that was part of what we went through in Cygnus, so I did have an understanding that if you had a pandemic of that scale, then you would need to make uncomfortable choices that would require moving people around the system.
Counsel Inquiry: Yes.
Mr Vaughan Gething: And that would probably require stopping some things to allow more capacity to be created.
So there was a final part to your question as well?
Counsel Inquiry: Yes, contact tracing, moving patients around, quarantining and lockdown.
Mr Vaughan Gething: Yes. So on quarantining, I have heard the evidence of Dr Sandifer this morning and I did understand, because of particularly some of the localised outbreaks we had, that quarantining in community or family groups was entirely possible, but not at the scale that was envisaged and there was not a genuine consideration of the scale or the depth of the Covid pandemic, so there wasn’t then a consideration presented to me – and I think this evidence is common to all nations in the – UK, of the scale of the lockdowns that were then considered and implemented during the Covid pandemic. So in terms of preparation there wasn’t preparation that considered that scale of lockdown.
Counsel Inquiry: We’ll come to deal with Operation Cygnus in a moment, but just on the issue of your level of knowledge, did you as Minister for Health, commission any research, advisory papers or briefings to you as to what the evidence was telling the scientists in terms of this pandemic influenza hazard?
Mr Vaughan Gething: No, because I did rely on the briefings that I received, on the advice I received.
Counsel Inquiry: So nothing –
Mr Vaughan Gething: It’s hard to second-guess the advice you’re being given as a minister, whether you’re new or not, and to decide which areas you do want to try to second-guess on it, and I did rely on the advice provided and the provisions within it, and obviously in hindsight there are good reasons to question and to look afresh at what we do.
Counsel Inquiry: But nothing in the briefings that you received, nothing about the detail of the pandemic influenza threat caused you to request any further advisory papers or evidence gathering to take place in order to try to work out what Wales needed to do to mitigate this threat?
Mr Vaughan Gething: No, I had advice from officials who had expertise, and obviously you’ve heard the way our system is constructed with Public Health Wales and others within it, that advice was provided, and at the time I had no reason to go and to want to go behind it or to question it, so I did rely on the advice I was given.
Counsel Inquiry: You tell us in your witness statement that you first read the Pan-Wales Response Plan in January of 2020?
Mr Vaughan Gething: Yes.
Counsel Inquiry: Yes, did you know of its existence before that date?
Mr Vaughan Gething: I think, again, it was referred to and briefed in and around Cygnus, but I read it in the January, and that was after, obviously, the first indications about Covid in China.
Counsel Inquiry: You tell us at paragraph 37 in your witness statement:
“My impression of the Plan, as a layman and someone without any previous experience or knowledge of pandemic preparedness, was that it was considered and reasonable. I do not think I first saw it [as we’ve established] until January 2020.”
Is it right, Mr Gething, to describe yourself as a layman when you had been the Cabinet Minister for Health since 2016?
Mr Vaughan Gething: I’m describing myself in comparison to, for example, the people you’ve already heard evidence from. I wasn’t the Chief Medical Officer or the Medical Director of Public Health Wales or the people involved in emergency planning, so in that sense it is a lay perspective, but obviously compared to the wider population I’ve got experience in government of doing a range of things.
Counsel Inquiry: Describing yourself as having no previous experience or knowledge of pandemic preparedness when you had been four years in post might be surprising to some people.
Mr Vaughan Gething: Again, I think if … I’m trying to be clear about the difference between myself and people involved in the detail of emergency planning. So compared to the general population, I certainly had more experience and knowledge, and I’m trying to be clear about that distinction rather than trying to go beyond it.
Counsel Inquiry: What level of contact did you have with the Chief Scientific Adviser for Health, Dr Rob Orford?
Mr Vaughan Gething: I saw Dr Orford on a number of occasions through the year. So in the pattern of that sort of engagement, I would have a regular meeting with the Chief Executive of NHS Wales, I’d have a regular meeting, normally at least monthly, with the Chief Medical Officer, sometimes sooner, and for some officials like Dr Orford I’d probably see them three or four times a year in set meetings. So, for example, some of the points that have been described around investing in our genomics capacity, some of that came from conversations with Dr Orford and Dr Atherton about what we needed to do. So I was – I knew who Rob was, I’d met him on several occasions before we get into the depths of the Covid pandemic.
Counsel Inquiry: Between you taking office in 2016 and the onset of the pandemic in 2020, were you aware that the Chief Scientific Adviser for Health had no involvement in pandemic preparedness planning?
Mr Vaughan Gething: No, I wasn’t aware of that specifically, no.
Counsel Inquiry: Does that surprise you?
Mr Vaughan Gething: In retrospect, it is, because he had such a role in giving advice to ministers when we actually had to deal with the scale of the pandemic.
Counsel Inquiry: Were you aware during your time in office of the Welsh Government risk register?
Mr Vaughan Gething: Yes, I knew we had a Welsh Government risk register.
Counsel Inquiry: Did you ever read it?
Mr Vaughan Gething: No.
Counsel Inquiry: Were you aware of the Health and Social Services Group risk register?
Mr Vaughan Gething: Yes, and I would discuss that from time to time as(?) it was raised with me by the Director General at the time, obviously who was Dr Goodall.
Counsel Inquiry: Did you read it?
Mr Vaughan Gething: No, I don’t think I did go through and read the risk register.
Counsel Inquiry: You tell us at paragraph 19 in your witness statement:
“My impression was that UK Ministers did not take ministers and officials from the devolved governments seriously.”
Is that how you felt all the way through your time as Cabinet Office Minister? Cabinet Minister, sorry.
Mr Vaughan Gething: It changed during the course of the pandemic, is –
Counsel Inquiry: Right.
Mr Vaughan Gething: So actually until that time, yes, that was my clear impression; and, with respect, I think the evidence of Mr Hunt confirms that.
Counsel Inquiry: Did you raise your dissatisfaction with how the UK ministers treated you as a devolved minister with any of the UK ministers at the time?
Mr Vaughan Gething: Well, that was challenging, because there was a choice about the lack of contact, which I go through in my evidence. Correspondence would either not be answered or take months to answer, as I set out. So it was one of the challenges, was that – the point about contact was a deliberate choice from the UK side, and my view has always been there is plenty of room for the political disagreement but there also has to be space made for pragmatic engagement because we always need to do business together on a range of things.
Counsel Inquiry: In your view, Mr Gething, did the strained ministerial relations hamper pandemic preparedness in Wales?
Mr Vaughan Gething: Yes, I do think they had an effect, I think they would have been better if we had had some form of ministerial engagement beyond the Cygnus exercise.
Lady Hallett: To be fair, I don’t think Mr Hunt said that he accepted that the UK ministers hadn’t deliberately contacted you or avoided you or treated you with disrespect, what he said was there was a difficult political relationship.
Mr Vaughan Gething: Again, I think that Mr Hunt’s evidence does not disagree with my evidence, he simply does not agree with the positive points that I make that it was a choice. We would request meetings. We wrote on a number of issues. We didn’t write every week, it wasn’t, “We’ll write a letter and see if we get a response”, when we wrote on real and serious issues we did not get a response or it took a very long time to get a response, and that isn’t an accident. They knew who I was and what I was writing for.
In no-deal Brexit preparation, I did not meet the Cabinet Minister for Health, whether it was Mr Hancock or Mr Hunt, and again that’s a choice. When you then have to deal with each other, as we did, you were starting relationships from anew with someone you’d never met, and I think that is suboptimal.
Lady Hallett: He did mention that there were good relationships between officials even if the politicians weren’t getting on, as perhaps most of us would like to think they would try to get on. In what way do you think things might have been different if the ministers had had the kind of contact one would hope and you were talking about?
Mr Vaughan Gething: When ministers talk and pragmatically agree, it always helps to speed up decision-making, and it can often help to highlight risks and opportunities. I see that in my current role as well as my previous one. So I do think that if there’d been ministerial engagement even only once after Cygnus it would probably have moved along preparedness for all of us.
I say in my own statement that I think that there were good relationships between officials, but, as I say, I think it would have been assisted if, despite the fact that we are politically very competitive, especially around the politics of the health service, there should always be room for some pragmatism and you have to do business. You don’t have to like the person on the other side of the desk, but you should from time to time meet.
Ms Blackwell: Thank you, my Lady.
Was it your experience as a minister, Mr Gething, that the public-facing political concerns set the agenda, and that was to the detriment of forward planning for things like a pandemic influenza?
Mr Vaughan Gething: So the public facing concerns definitely affected the agenda because every day something could happen that you would end up having to deal with as the minister. That’s life in ministerial office, especially if you’re a health minister.
At the start of the term, what we’re trying to do was to deliver a long-term plan for health and social care, and so I was trying to do that whilst dealing with the very headline issues as well. So, yes, it did mean that other issues had less attention. Antimicrobial resistance, for example, I know it was mentioned in evidence earlier today, that was an issue that got occasional attention between not just myself but in the animal health field, veterinary health field as well. Pandemic preparedness was never a subject of questions, never a subject of scrutiny within the Welsh Parliament, and I suspect that will change and that will be a change for the better.
Counsel Inquiry: Does that mean at the time that there was limited – it was given a limited priority by the government?
Mr Vaughan Gething: It didn’t have the same priority as those headline issues that did take up lots of the life and the energy of the government, and I know you’ve heard from other evidence that there was – preparedness was taking place but it wasn’t – it didn’t have the same intensity that trying to deliver a long-term plan had or responding to the latest very public challenges that our whole system, not just the minister, would have to deal with.
Counsel Inquiry: Do you think that there needs to be a check on what is appearing or coming down the line in the long term as well as the focusing of ministers’ attention on the here and now?
Mr Vaughan Gething: That’s the difficult balance to strike. So at the end of 2018 and into 2019 I was dealing with a maternity – a significant cluster of serious harm in maternity services in the Cwm Taf health board, so that was an issue that I wasn’t aware of until it was brought to my attention by officials. I then had a meeting where we then had to do a number of very difficult things, and that took time that – that was entirely appropriate and it was the right thing for my time to get directed at, but it meant that other things then needed to move.
So there is the challenge of what comes up, where you do need to shift your priorities, as well as your point about longer term priorities, and that’s definitely a lesson learning point, not just for people in the government but more widely as well I think.
Counsel Inquiry: I want to turn now to discuss with you your knowledge and involvement in the exercises that the Inquiry has heard so much about.
The Inquiry heard this morning in questions put to Dr Goodall about an exercise in April of 2009 called Taliesin. During your time in office, were you aware that that exercise had taken place?
Mr Vaughan Gething: It’s Exercise Taliesin, Welsh poet.
Counsel Inquiry: I do beg your pardon.
Mr Vaughan Gething: But no, I wasn’t aware, and of course 2009 is before I was elected.
Counsel Inquiry: Yes, I understand that, but the result of that exercise and one of the recommendations being consideration given to the social care sector, that wasn’t something that was brought to your attention?
Mr Vaughan Gething: Not in pandemic preparedness and planning terms, but the social care sector was very important to me in terms of running the whole health and social care system, that’s why we had a long-term plan for health and social care, but not in the specific context of pandemic preparedness and planning.
Counsel Inquiry: The first Exercise Cygnus, in 2014, which was held in Wales, were you aware of that exercise at the time? I think you might have been Deputy Minister for Health at the time that that took place, or indeed shortly afterwards.
Mr Vaughan Gething: Yes, so I started in September 2014 as the Deputy Health Minister, but I wasn’t aware of the Wales-only Exercise Cygnus operation.
Counsel Inquiry: All right. One of the recommendations that this Inquiry has heard fell out of that exercise was the concerns around the capacity and readiness of privately owned care homes to be able to cope with the likes of a pandemic and having their own contingency plans in place. So that wasn’t brought to your attention?
Mr Vaughan Gething: Not that specific – in relation to the pandemic. The broader points, though, about the future of the sector were much more in my mind. And, as the deputy minister, delayed transfers of care is definitely an area where you can’t resolve that without health and social care working together, but that’s not the same as looking at it through the lens of pandemic preparedness.
Counsel Inquiry: Whilst you were in the role of Deputy Minister for Health, were you aware of Exercise Dromedary that took place in 2015?
Mr Vaughan Gething: No.
Counsel Inquiry: That was a Public Health Wales multi-agency exercise dealing with the outbreak of one case of MERS CoV coronavirus, in which surge capacity wasn’t tested but was mentioned. That’s not something that was on your radar as Deputy Health Minister?
Mr Vaughan Gething: No, and essentially my role as a Deputy Health Minister was virtually everything that had a target on it, that had a number, was then my responsibility, including all of the media that went with it. So it wasn’t actually part of the role that I had as the Deputy Health Minister.
Counsel Inquiry: You don’t mention Exercise Alice in your witness statement, which we know was delivered in February of 2016 by the Department of Health. Was that something that was within your knowledge when you became Cabinet Minister?
Mr Vaughan Gething: No. So when I became the Cabinet Minister in 2015, and then in 2016 I am now aware that Exercise Alice has taken place, but I think it was a Public Health England led exercise, so I wasn’t aware of it, no.
Counsel Inquiry: Yes. In your briefing for Exercise Cygnus later on in 2016, were these previous exercises, and in particular I’m going to highlight the issues that they raised with social care, not brought to your attention?
Mr Vaughan Gething: Not in the sense of pandemic preparedness. So around the exercise and the briefing and the conversation that takes place, then actually social care is part of the system-wide challenge that you’re trying to understand and run an exercise for.
Counsel Inquiry: Did you have any direct involvement in Exercise Cygnus in October 2016?
Mr Vaughan Gething: Yes, I attended ministerial meetings on both days as requested. My deputy at the time also attended some of those exercises as requested. So on both of the days when ministerial attendance was requested we both attended and participated.
Counsel Inquiry: It was a huge exercise, wasn’t it?
Mr Vaughan Gething: It was, it involved a range of people. I remember having the briefing with Dr Atherton and I remember sitting down in the basin of Cathays Park in the control centre where it was run from and participating in those meetings.
Counsel Inquiry: Was it important to you that all relevant learning from Exercise Cygnus was carried forwards and incorporated into Wales pandemic planning?
Mr Vaughan Gething: Yes. And as I think I describe in my statement, I understood there would be lessons learning, there would be an officials route(?), both within Wales as well as with other partners, and I expected that the learning from that would then be implemented. My own impressions from the exercise were that there were positives and there were things that I would expect to be worked on.
Counsel Inquiry: The way in which you describe it in your witness statement at paragraph 67 is:
“I was advised that learning points had been identified and would be implemented … either in whole or in part, or that there was a delay in implementation. For that reason, I assumed, absent any advice to the contrary or questions in the Senedd, that the lessons of Exercise Cygnus had been applied.”
Did you read the Exercise Cygnus report, Mr Gething?
Mr Vaughan Gething: I can’t recall which report are you referring to, because there are a number of notes that come after it and there is then the briefing I receive from officials, so let’s be clear about which report.
Counsel Inquiry: Well, I’ll put it on screen.
Mr Vaughan Gething: Thank you.
Counsel Inquiry: It’s INQ000022792, please.
So this is the report following the three-day exercise in October of 2016.
Can we go to page 6 and paragraph 3, please. Under “Key Learning”, thank you:
“The analysis of the evaluation reports from the organisations participating in the exercise indicate that the UK’s command & control and emergency response structures provide a sound basis for the response to pandemic influenza. However, the UK’s preparedness and response, in terms of its plans, policies and capability, is currently not sufficient to cope with the extreme demands of a severe pandemic that will have a nation-wide impact across all sectors.”
Let’s just pause there. Do you remember reading that in October of 2016?
Mr Vaughan Gething: No.
Counsel Inquiry: Had you read it, would that have caused you some concern?
Mr Vaughan Gething: If I had read this, and with respect I think it was produced after October 2016, I’m not sure of the exact date, but whenever, if I had read that paragraph, then I – I almost certainly would have asked extra questions about what was then taking place, and there is definite learning from that about – again, I made the point earlier about where ministers’ time is used. If I had read that I think that I almost certainly would have asked more questions and asked for more assurance about what was happening.
Counsel Inquiry: Can we take it that you didn’t read the report?
Mr Vaughan Gething: No, I didn’t. I did not read this report. I recognise the front now in preparation for it.
Counsel Inquiry: Did your advisers feed back to you the fact that there were real concerns about the capacity of the United Kingdom preparedness and response?
Mr Vaughan Gething: My advisers fed back, and you’ve got the documents, that there was a need for improvement, there was a need for learning to be applied, and I received briefings on the progress of those during 2017, 2018 and 2019, and I know you’ve got some of the email trains around that as well.
Counsel Inquiry: What steps did you take, then, to satisfy yourself that Wales would be prepared for the next pandemic?
Mr Vaughan Gething: Well, I engaged with the briefings I received from my officials, and you’ll know that at various points I have asked about follow-up from different parts of the sector, and I know you’ve also been through, for example, the improvements, the investment in microbiology, a range of other things that happened. So there were different decisions that I made.
Looking back, I think it is fair to say that if I had put more ministerial time into this, then I may well have sped up preparedness.
Counsel Inquiry: Was social care on your radar as Cabinet Minister?
Mr Vaughan Gething: Yes. I’ve set out earlier that social care was part of the departmental responsibility, and at the start of the term my deputy and I at the time invested fairly significant time and then through the rest of that period in not just having the long-term plan to cover both health and social care but actually direct time with local government and with partnership boards bringing health and the third sector together, because we knew that you can’t have a long-term future for the health service without social care being part of the answer.
Counsel Inquiry: Did your advisers bring to your attention that, as part of Exercise Cygnus, the local resilience forums had expressed concerns that it was not possible to collate an accurate picture of social care capacity because much of the capacity lay with private providers?
Mr Vaughan Gething: Not specifically in those terms, but I’m obviously aware of the structure of social care and how it has changed significantly over the last few decades.
Counsel Inquiry: You will be aware now that that concern is something that was raised as far back as Exercise Taliesin, and nothing appears to have been done about it in the meantime; is that a concern that was ever brought to your attention when you were Cabinet Minister for Health?
Mr Vaughan Gething: Not in those specific terms. Like I said, the concerns about social care were broad and not simply focused on pandemic preparedness, it was much more about the stability of the sector, given the demands that it faces. And the structure of it is part of that too.
Counsel Inquiry: Did you cause for any research, briefings, action to be taken as a result of what you knew to be the problems with social care during the time that you were Cabinet Minister?
Mr Vaughan Gething: Yes, we invested in social care, it was part of our plan for the future. I made deliberate choices to put parts of the NHS allocated budget into partnership space that had to be used by health and social care working together through the seven regional partnership boards that we’d created. So social care was definitely part of what we were concerned about, and wanted to invest in its future, and that did also take into account the structure of the service, what improvement could look like, and the broader vulnerability within the sector as well.
So you’re thinking about different models for social care so it’s more sustainable, who the new actors are going to be. There are lots of relatively small family-run homes that give you different vulnerability. If people retire, that home can go and you potentially have a number of residents who may not be able to carry on. So that was a challenge, and the way that it’s commissioned and funded is also a key risk as well. And all those challenges, in the way I’ve described them, would still exist now, but we’re in a better position now than when I started, and I expect we’ll be in a better position in the future, because, you know, social care is essential for the future of the health service and it’s part of our – it’s part of our success story that lots of us can expect to live to be older and there is a need to plan for and to deliver against that.
Counsel Inquiry: Did you take any action on this recurring issue that there appeared to be no register of private care homes in terms of the contingency plans for a pandemic or for any sort of outbreak that they might have? Did you take any action on that?
Mr Vaughan Gething: No, not on that specific point.
Counsel Inquiry: Are you aware, Mr Gething, that following Exercise Cygnus there was a group created called the Wales Pandemic Flu Preparedness Group?
Mr Vaughan Gething: Yes.
Counsel Inquiry: Did that group ever report directly to you?
Mr Vaughan Gething: I received briefings from that group. The named individual who provided those briefings is David Goulding, and he is referred to in the papers.
Counsel Inquiry: Were you aware that during a meeting of that group, the following was discussed:
“Adult social care and community healthcare.
“NR advised that there was currently an issue around who would be the SRO for the social care workstream within the Department of Health. He added that within Wales he was trying to establish where there was social care capacity but the task was extremely difficult as most of the care provision was provided by independent companies.”
So, in other words, there was a restatement of the problem, knowledge of private social care?
Mr Vaughan Gething: Yeah, and that – that’s part of what you’re looking at across the whole system, regardless of the purpose, because understanding who’s providing the care, understanding the commissioning arrangements that are largely led by local government and understanding the variety of different homes in each of the 22 authorities is part of the challenge we have, and had, when it came to dealing for this in very real terms.
Counsel Inquiry: Were you able to watch the evidence of Frank Atherton from yesterday or have you been able to receive a briefing on what that might have contained?
Mr Vaughan Gething: I’ve seen some of it. We had Cabinet yesterday so I wasn’t able to absent myself to watch all of it.
Counsel Inquiry: All right. Are you aware, then, that in an email trail from July 2018 there was concern expressed about the pace of development of the review and guidance which needed to be exposed to ministers, according to Mr Atherton, along with resource issues? In fact I think it might have been Mr Kilpatrick who sent the first email, but there was a chain, I think, referred to during the evidence of Mr Atherton which indicated that this concern needed to be brought to the attention of ministers?
Mr Vaughan Gething: Yes, I’m aware of the email exchange that was referenced yesterday.
Counsel Inquiry: Yes. Was that brought to your attention?
Mr Vaughan Gething: Not specifically in terms of that exchange, but I know you’ve heard other evidence about some of the other steps that were taken, but, for example, I didn’t then get at that briefing saying, “We need you to intervene, Minister, because we’re not making enough progress”. And there are times where you intervene and you say, “I want to know what’s happening”, or, “I want to meet officials”, and it does accelerate progress and provide renewed focus, but I don’t recall ever being briefed on that particular exchange or its outcome in relation specifically to, “We want you to be more engaged in pandemic preparedness to make sure that we accelerate the work that we’re doing”.
Counsel Inquiry: One of the concerns expressed in that email train was the fact that the Welsh Government appeared to be waiting for the Department of Health to issue guidance before it could assess and review its own plans and guidance. Do you consider that to be a problem for Wales, reactive rather than proactive?
Mr Vaughan Gething: Well, I think it’s always part of the challenge when you want to work across the four nations about where and how you do that, and to do that in a way where you can have your own plans to do what you want to in Wales, whereas in the pandemic scenario you know it’s likely to affect all four nations and so you want some deliberate consistency. Or if you’re going to do things differently, to understand why. And because England is a much bigger block within the UK, and it’s likely that if you have a future pandemic it will come through England first – that’s just the reality of travel patterns and population size – that you would want to have that come through. So, again, if that was put in front of me as a minister, I would – and it goes back to, I think, my Lady’s questions about what could be helped – if I’d had a briefing that said, “We haven’t got this in the Department of Health in England, it would be really helpful, and we also need to make sure that we have a greater focus in the Welsh Government”, one of the things you could have done as a minister would be to say, “I want to know more about this, I want to know what has happened within a certain timescale”, and often that is something you do, say, “I want to know within three months what’s happening, and I want to have the officials in front of me”, that kickstarts people to do things within a timescale, and you could have written or asked for a conversation with a UK minister, and that’s one of those challenges, where you do have correspondence, it isn’t political, where not having better relationships does get in the way of doing government business that has to take place.
Counsel Inquiry: One of the issues which Wales could have grappled with, without having to wait for the Department of Health to act, is getting to grips with private care home capacity and ensuring that they had in place contingency plans, isn’t it?
Mr Vaughan Gething: So I think that’s fair. I think it’s fair to say that we could have made more progress with our own sector. The prime concern about the social care at the time was its vulnerability and sustainability full stop, and so actually that still means needing to understand who is in the sector. In general terms you had an understanding about the average size of homes, but actually the more granular detail, to understand, with local authorities in particular but also the health service, the numbers of homes, where they are, and in this area their infection prevention and control procedures in general terms as well as the specifics around the pandemic.
Counsel Inquiry: Right. Finally, Mr Gething, I want to ask you about PPE.
Lady Hallett: It’s all right.
Ms Blackwell: Not at all, I was just pausing.
Lady Hallett: It’s the pollen.
Ms Blackwell: It’s affecting us all.
At paragraph 35 in your witness statement you say:
“We have learned a great deal about the importance of PPE supplies, the adequacy of our stockpile, the importance of secure supply chains and the trade-offs between price and security of supply.”
What do you mean by the trade-off between price and security of supply?
Mr Vaughan Gething: So we had operated a just-in-time system where price drove most of our procurement decisions, including on PPE, and one of the lessons is about the length and the fragility of those chains and, again, I think it’s common evidence from a number of people that they collapsed in the face of the pandemic. So if we want to be more resilient in the future we would need to carry on investing in PPE production that is closer to home. That would almost certainly mean that it will cost more, and the challenge there is that whoever is in whichever part of the government across the four nations of the UK, there are political and financial choices that come with that.
If you want to invest in having a supply that you know is more expensive than you could buy in another part of the world but you’re doing it because you want to make sure you don’t have fragility if there is a future pandemic, you’ve got to be prepared to do that, and that has a budget consequence to it.
It’s the same with other areas of preparedness as well, and, you know, I have looked at Mr Hunt’s evidence and he talks about South Korea, so not just on PPE but on improving capacity in laboratories, for example, well, that isn’t just the capital involved in building a facility, you need the people to do that, and you’ve got to invest on a recurrent basis for that to happen.
So those are choices and that resilience, if you’re looking to build it in, if you need more capacity you can’t avoid the fact that that will cost more money, and that’s a choice that we have to be prepared collectively to make. I think that holds regardless of who is in government in whichever part of the UK.
Counsel Inquiry: Were you aware that Welsh and UK-wide planning assumptions were to plan for successive flu waves to each last approximately 15 weeks in duration?
Mr Vaughan Gething: Yes.
Counsel Inquiry: All right. I’d like to just look, please, at the document which sets out the stockpile held in South Wales of PPE.
It’s at INQ000066526.
Just reminding ourselves that the central PPE stockpile for Wales was the pandemic influenza preparedness programme stockpile. This is Audit Wales’ report entitled “Procuring and supplying PPE for the Covid-19 Pandemic”. It’s dated April of 2021.
Now, this will be the subject of evidence in later modules, but I’d just like to look, please, at page 21 and paragraph 1.26 to ask you about the planning and whether or not it was sufficient.
Can we highlight, please, the table in the middle of the page.
Mr Vaughan Gething: Yeah.
Counsel Inquiry: This is the quantity of items in the PIPP stockpile, as we’ve just established, in March 2020, and how long it lasted: aprons, six weeks; eye protectors, ten weeks; type IIR masks, which are of particular use for care homes and hospitals, 5.5 weeks; FFP3 respirators; 10.9 weeks; gloves, singles, 1.5 weeks; hand sanitiser, 4.3 weeks.
Even if we acknowledge that the assumptions that the Welsh and UK Government were planning for were not strictly adhered to by the Covid-19 pandemic, in fact in some senses they were worse, weren’t they? Do you agree that the PPE stockpile in Wales was woefully inadequate to deal with the pandemic that was being planned for?
Mr Vaughan Gething: Yes, so our collective planning assumptions did not stand up against reality. So they were not adequate for the challenge we then faced, and that is set out in the table. I think it’s very, very clear. And that –
Lady Hallett: I don’t think, with respect, sorry to interrupt, that wasn’t the question.
Mr Vaughan Gething: Sorry.
Lady Hallett: The question was the planning was for something that was going to last for 15 weeks.
Mr Vaughan Gething: Yes.
Lady Hallett: The point that Ms Blackwell is making is that it didn’t even last 15 weeks, not just Covid.
Mr Vaughan Gething: No, and that was – and I remember having a conversation about this time. I want to try to avoid going too far into the actual response.
We were going through PPE at a much faster rate than our planning assumptions assumed we would, so actually we found that our stockpile that should have lasted for a whole wave didn’t. And, you know, the rate at which we were going through it was much faster than we expected, and it’s why in the very early stages this was one of my major concerns in practice. But I don’t want to get drawn too far into what I know we’ll be going through in Module 2.
Ms Blackwell: So do you agree, Mr Gething, that the plan that was in place was not just a plan for the wrong pandemic, but it was an inadequate plan in any event, even for the pandemic that it was being created for?
Mr Vaughan Gething: I think it’s fair to say that the plan for an influenza pandemic would still have had challenges. If we’d had an influenza pandemic – I hesitate to say it was inadequate because it’s such a loaded term, but it certainly – with all the evidence that I’ve seen, and I know the Inquiry have seen, the planning for an influenza-type pandemic was not complete, and we would have had vulnerabilities if it had been an influenza pandemic.
Counsel Inquiry: Thank you.
My Lady, those are all the questions I have for Mr Gething. You have provisionally provided permission for a series of questions all to be asked by Covid-19 Bereaved Families for Justice Cymru. Please may that be done now?
Lady Hallett: Certainly.
Questions by Ms Shepherd
Ms Shepherd: My Lady.
Lady Hallett: Ms Shepherd.
Ms Shepherd: Mr Gething, my name is Laura Shepherd and I appear on behalf of Covid-19 Bereaved Families for Justice Cymru.
I’m going to start off by asking you about stakeholders. I don’t know if you heard the evidence of Rosemary Gallagher that she gave last week. She spoke about the engagement or perhaps lack thereof that she had with the United Kingdom Government. Did you as Health Minister invite the Royal College of Nursing or the British Medical Association or any other clinical stakeholder groups to have input into the Welsh Government’s pandemic planning?
Mr Vaughan Gething: No, I didn’t ask for royal colleges to take part specifically. In the way that pandemic planning was undertaken, you have had this evidence from a range of people, officials within the Welsh Government worked with a range of partners, but I’m not sure whether they did engage with the royal colleges or not. But I did not see Rosemary Gallagher’s evidence on this point.
Ms Shepherd: Were you aware that in her report in 2011, Dame Deirdre Hine, this was following the swine flu pandemic, she advised as to increased stakeholder engagement in pandemic planning?
Mr Vaughan Gething: Yes, I’m aware of that in preparation for this Inquiry. I’m not sure if she defined the list of stakeholders, but I’m aware that it was one of the recommendations.
Ms Shepherd: I’m going to move on now to ask you about surge capacity. So you have been asked questions about the sufficiency of the PPE stockpile, and I know that you heard the evidence that was given earlier by Andrew Goodall, and he spoke about the workstream that was in place as to surge capacity and how that wasn’t finalised before January 2020.
When it got to the pandemic, do you agree that there was a difficulty with surge capacity in Wales?
Mr Vaughan Gething: Yes, there was a difficulty in surge capacity in Wales, as in the rest of the UK, and the challenges, during a surge capacity it’s not just a facility, it’s people you need, and that is the big challenge. So if you could invest in more people you have more capacity to surge to, but those people will be working before you need to change things. So the ability to surge is about people, it’s partly about facilities, it’s also – and I think I went through this briefly in questions earlier – you have to choose what you’re not going to do to create that space, whether that’s the number of people who you would then expect to provide care to give you more capacity, or whether that is stopping some services from happening, or reorganising the way that they do.
Ms Shepherd: Were those choices made in preparation or were they made at the time when Covid hit?
Mr Vaughan Gething: So some of that work had been done in preparation, I know you heard this from Dr Goodall, the work hadn’t been concluded but the thinking about it was not starting from a zero base. The challenge then is when it happens you have to think very quickly. That’s why the workstream on regulation is relevant as well, because part of that surge capacity was a change in regulation that was swiftly introduced, and was envisaged, actually, in terms of pandemic preparedness, to allow you to have people put back on the professional registers to undertake work they wouldn’t otherwise have done, and that of course relies on those people wanting and being prepared to come forward.
So I guess fair to say that the work wasn’t complete, but it doesn’t mean that nothing had happened, because when the time came there was thinking to rely on as well as the need to make choices.
Ms Shepherd: I just want to have a look at some of the planning presumption when it comes to surge capacity.
If we could have up on the screen, please, INQ000089573.
This is a document you’ve already been referred to today, this is the Wales Health and Social Care Influenza Pandemic Preparedness and Response Guidance dated February 2014.
If we could have a look at page 7, please. So in the box there in the middle of the page, the very top row in that box says:
“Up to 50% of the population could experience symptoms of pandemic influenza over one or more pandemic waves each lasting 15 weeks.”
Then if we look a couple of boxes down it says:
“1-4% of symptomatic people may require hospital treatment.”
So that’s up to 2% of the entire population of Wales in hospital, potentially in a 15-week period. Was Wales prepared for that?
Mr Vaughan Gething: Not in the sense we had the hospital capacity at the start of the pandemic. That’s a simple matter of the maths of the matter. To be prepared to know that you might have to do that in general terms we didn’t have a granular plan on: here is how we will create that capacity.
I think it’s also fair to point out, Ms Shepherd, that the planning assumptions are on the reasonable worst-case scenario, so that is if you’re not taking action, and actually of course we did act, and the assumptions are these things can happen if you don’t take action.
What we did meant that fortunately 2% of the population did not require hospital treatment, and to create the capacity for that – again, I’m trying not to get drawn into Module 2, my Lady, but of course we did have to rapidly go through some of the challenges around field hospital expansion.
Ms Shepherd: I’m going to move on now then to excess deaths, and what I mean by this is the measures in place to deal with that, body bags, mortuary capacity and the ability to maintain the dignity of those who died.
According to a Welsh Government document from the Technical Advisory Group, there were 2,257 deaths involving Covid-19 between 1 March 2020 and 31 May 2020, so that’s a period of 12 weeks. Wales was not prepared for that number of deaths, was it?
Mr Vaughan Gething: I think in terms of the briefing that I had, excess deaths were mentioned. I was aware there was work on excess deaths that needed to be completed. I don’t think that work was finalised. The most difficult part, I think, is not the physical capacity, it’s the dignity in death that I found most difficult.
Ms Shepherd: If we could have a look again, please, at the INQ000089573 document, page 7. Again we’ve got excess deaths below the table on page 7, and again it says here:
“Planners should aim to be able to cope with between 12,000, and 15,000 deaths in Wales …”
That’s over a 15-week period, and we had just over 2,000 deaths in Wales over a 12-week period. Do you accept that that lack of preparation led to real pain and suffering of the bereaved in Wales?
Mr Vaughan Gething: I think, in honesty, addressing the issue of excess deaths does lead to pain and suffering and it did lead to it, because, as I say, one of the things I found most difficult was the dignity in death, and knowing what a bad death is and understanding that that has a real impact on people who are left behind, and when we started and had to consider the measures we might have to take immediately for mortuary capacity and for crematoria – and I knew that crematoria capacity and there were plans that had gone through and been discussed with partners about how to increase crematoria capacity, but actually all of this work was not fully completed, and that meant that when Covid came, we were not as prepared as we could and should have been, and that does, yes, Ms Shepherd, lead to additional pain for bereaved families.
Ms Shepherd: Do you accept that you had responsibility to plan for that?
Mr Vaughan Gething: Yes, I’m the minister in the government, of course it’s my responsibility.
Ms Shepherd: There is one final area I wanted to ask you about, and that’s infection control and in particular isolation rooms in hospitals. The evidence that we heard earlier today from Dr Sandifer, and we also heard it yesterday, was there was no provision in Wales whatsoever to deal with HCIDs, which means that if people in Wales – if someone in Wales has an HCID, they’re taken to London or I think it’s Newcastle. Do you accept that lack of preparedness for even one case of SARS in Wales reflects a big oversight from those who were responsible for pandemic preparedness?
Mr Vaughan Gething: No, and I think the reason is important. So if you have two centres in England, you’re dealing with very small numbers of a high-consequence infection. The challenge we are looking at is how do we make sure we have the ability to deal with a small number of high-consequence infections. For the scale of the pandemic, the centres in London and Newcastle could not cope and would not reasonably cope. Actually the challenges around how you surge capacity, as we had to with intensive care and more, is much more relevant to pandemic preparedness and coping with a genuine pandemic, as we did in the early stages of containment, and I think Chris Whitty has given evidence on this as well, I don’t think it would have made any difference if we’d had a centre in Wales. If that had been in the Heath in Cardiff, if you live in Betws-y-Coed, that wouldn’t have been the place you would have gone anyway. So there is a challenge about understanding the difference between a very small number of high-consequence infections – if you recall, when there was a nurse who returned from the work she was doing and the challenge around Ebola, actually that is where you have those very limited number of high consequence facilities. The pandemic is a different order.
Ms Shepherd: SARS was an HCID until March 2020 and there was not – sorry, Covid – coronavirus and SARS was HCID until March 2020, and there was not one single isolation unit in Wales that could deal with it, was there?
Mr Vaughan Gething: Not at that time, no. And, as I say, in terms of – I think we are maybe talking about different points here. Having an individual unit with a small number of beds would not have prevented the challenges of the pandemic. The scale and the depth of what we needed to prepare for and to deal with would not have been changed if we’d had four high-consequence infection beds at University Hospital Wales in Cardiff. That’s the point I’m trying to make. I think there’s a danger that you say, “This is the issue”, when actually it’s the much broader challenges of preparedness I think that are the real challenge.
Ms Shepherd: Thank you, my Lady.
Lady Hallett: Thank you very much, Ms Shepherd.
Ms Blackwell: My Lady, that completes Mr Gething’s evidence.
Lady Hallett: Thank you very much for your help, Mr Gething.
The Witness: Thank you.
(The witness withdrew)
Ms Blackwell: Would that be a convenient moment to take our afternoon break before the final witness of the day.
Lady Hallett: Yes, of course. I’m just trying to think – it’s very important that we finish Mr Drakeford’s evidence today.
Ms Blackwell: Perhaps ten minutes? Sorry, you’re getting mixed messages.
Lady Hallett: I am getting mixed messages. Ten minutes. 3 o’clock.
(2.50 pm)
(A short break)
(3.00 pm)
Lady Hallett: Mr Keith.
Mr Keith: The First Minister of Wales, please.
Mr Mark Drakeford
MR MARK DRAKEFORD (affirmed).
Questions From Lead Counsel to the Inquiry
Mr Keith: Would you be good enough to give your full name, please, to the Inquiry.
Mr Mark Drakeford: Mark Drakeford.
Lead Inquiry: Mr Drakeford, thank you very much for the assistance that you have so far provided to the Inquiry by way of the provision of a witness statement. Is that a witness statement dated 21 April 2023 to which you’ve appended your signature and declared the statement of truth?
Mr Mark Drakeford: It is.
Lead Inquiry: Mr Drakeford, whilst you give evidence, could you please keep your voice up whilst at the same time not falling into the trap, into which a number of other witnesses have fallen, of speaking too fast for our stenographer.
Mr Drakeford, it is very well known that you are the First Minister of Wales and you have been so since December of 2018. But before that, from March 2013, were you Minister for Health and Social Services, and from May 2016 Cabinet Secretary for Finance and Local Government, and then November 2017, Cabinet Secretary for Finance?
Mr Mark Drakeford: I was.
Lead Inquiry: Your experience, therefore, reflects or is important for a number of areas in this module, because in practice you’ve worked inside, and of course you now lead, the Welsh Government since the outset of devolution, and you’ve worked as both Health Minister and Minister for Local Government, and therefore you have great experience of dealing with the system for health emergencies, as well as, of course, the resourcing for the preparedness structures in Wales.
Did you also have to deal with the Ebola outbreak whilst you were Health Minister?
Mr Mark Drakeford: That did happen while I was the Health Minister, yes.
Lead Inquiry: You may indeed even have been an adviser in government at the time of the swine flu pandemic before that?
Mr Mark Drakeford: That’s true.
Lead Inquiry: All right.
I’d like to start asking you questions, please, about devolution and the position concerning civil contingencies.
You are, of course, familiar with the Welsh Ministers (Transfer of Functions) Order 2018. That is a hugely important piece of legislation, secondary legislation, which came into force on 24 May 2018, and it transferred functions from ministers of the Crown in London to Welsh Government ministers in relation to the field of civil contingencies, as well as, I should say, a large number of other matters; is that broadly correct?
Mr Mark Drakeford: That is correct.
Lead Inquiry: So that we can understand the position, prior to that date were there a number of functions, activities, executive functions which were already within the competence of the Welsh Government, that is to say that they were not reserved, they were devolved matters, but they had not practically been transferred to the Welsh Government enabling you to be able to carry them out?
Mr Mark Drakeford: Well, the Welsh Government had been involved in dealing with civil emergencies from the very start of devolution. The very first year I was part of advising the Welsh Government we had a series of events in flooding, in fuel protests and foot-and-mouth disease, which illustrated that in fact, if not in law, the Welsh Government was drawn in to responding to those civil emergencies, and that continued to be the case in the decade and more thereafter.
Lead Inquiry: But legally some of the functions which you were required, obligated to carry out would or were on one view still reserved matters which had not been converted into devolved matters, enabling you to act legally, or were matters which had been changed into devolved matters but the piece of secondary legislation formally confirming that they were powers that you could exercise hadn’t yet gone through, but you just got on with the job?
Mr Mark Drakeford: In many ways the Transfer of Functions Order regularised the way in which things had happened on the ground for some time.
Lead Inquiry: An important part of that order concerned part 1 of the Civil Contingencies Act 2004, the United Kingdom legislation concerned with civil contingencies, because until the order was made transferring functions from ministers of the Crown to the Welsh ministers, the Welsh Government was unable to pass regulations under that Act and also formally to discharge the functions specified by the Act itself; is that broadly correct?
Mr Mark Drakeford: That is correct, yeah.
Lead Inquiry: There is evidence before my Lady’s Inquiry that until the Transfer of Functions Order, much of the discharge of civil contingencies powers by the Welsh Government was therefore framed not by that legislative framework or the legality of the functions order, but by the views of the First Ministers in place at the time and senior Welsh ministers. You were, in other words, forced back into the position of making decisions yourselves as ministers, as executive ministerial decision-makers, regardless of the legal position and the application of the Civil Contingencies Act; would you agree?
Mr Mark Drakeford: Only in part, I think, because many of the emergencies which were dealt with over that period relied on other powers which were already in the hands of Welsh ministers.
So I could give you one example, while I was the Health Minister there was a major measles outbreak in South Wales. It was a public health emergency, but all the powers that we needed to respond to that were already in the hands of Welsh ministers through the Public Health Act of 1984.
Lead Inquiry: Presumably, in anticipation of the Transfer of Functions Order being made, and it was an order which you had sought of course, politically the Welsh Government had for some time stated to the United Kingdom Government, “It is time for these functions to be transferred, let us make de jure what is already de facto”, presumably you had to make sure that the Welsh Government structures, in terms of resourcing, the personnel, the group or committee structure, was ready to discharge the new functions which it would be allowed to carry out?
Mr Mark Drakeford: Well, the normal pattern would be that a transfer of functions is accompanied by a transfer of funding to discharge those functions, because those functions are already being discharged elsewhere. So you no longer need to discharge them at central government level and the funding follows. So it would be true that the Welsh Government was responsible for making sure that, in terms of structures, that we were ready to discharge those new responsibilities. In this case, as I think the Inquiry will know, no funding followed from the United Kingdom Government for these purposes. So funding had to be found from within wider Welsh Government resources that would otherwise have been used for other purposes.
Lead Inquiry: So looking at those three areas of resources, personnel and the structure, in terms of resources, the Welsh Government was keenly aware that it would need extra resources in order to be able to discharge the additional functions which it was empowered to operate or would be empowered to operate from May 2018.
Did you seek from the United Kingdom Government additional resources to enable you to carry out those new functions?
Mr Mark Drakeford: Yes.
Lead Inquiry: What was the response?
Mr Mark Drakeford: Cabinet Office said that they had been unable to identify any expenditure that they had undertaken to discharge those functions, and therefore there was no money to be transferred. They could not identify any discrete sums of money used for those purposes in Wales, and therefore there was no sum of money that they could identify to accompany the transfer of responsibilities.
Lead Inquiry: So, in effect, because they were unable to specify how much the existing discharge of those functions cost them, in the general kitty, perhaps the general consolidated fund, they would not give you and could not give you the same amount of money in order for you to then discharge those functions going forward?
Mr Mark Drakeford: That was their argument.
Lead Inquiry: Therefore you fell back, of course, on your own funding sources?
Mr Mark Drakeford: We did. We employed eight new – or we created eight new posts within the Welsh Government to enable us to discharge these new responsibilities. But they were funded, as I said, not from the new money that you might have expected, but from money that was already devolved to Wales for the functions that the Welsh Government already possessed.
Lead Inquiry: May we take it from the fact that post-Covid the relevant risk and resilience directorate or division has many more people now in it than was the case in 2018, that the number of people you were able to fund fell short of, to use a word from earlier in the evidence, the optimum? You would, all other things being equal, had you had the money, have preferred to fund considerably more people than the eight that you were able to do so?
Mr Mark Drakeford: Well, my experience as Finance Minister taught me that you always had to think of two things: you had to think of the amount of money that you have available, but you also have to think about the capacity of a system to absorb that funding. Sometimes it’s not just a matter of finding the money. Systems can’t spend the money – can’t spend the money wisely if you provide it all too quickly. Capacity has to be built up over time. In the beginning, eight posts to take on these new responsibilities, I felt, as the Finance Minister having to find the money, that that was both something we could manage financially but also that the system would be able to use that money in a proper way.
Lead Inquiry: Let me ask you the same question in a different way, Mr Drakeford: had the United Kingdom Government provided the funding that you had sought, would you have still ended up with only eight people in that team?
Mr Mark Drakeford: Very hard question to be sure, given that they didn’t give us any money at all. We would have cut our coat according to our cloth.
Lead Inquiry: All right.
In terms of personnel, it wasn’t just a question then of being able to identify changes in personnel in the particular part of the Welsh Government, the Welsh Government resilience team, perhaps. What consideration was given to ensuring that, for the discharge across the board of these civil contingencies powers, more people would need to be placed in various other parts of the Welsh Government or outside the Welsh Government, either in relation to the audit teams or the local resilience forum level or the strategic co-ordination group level and so on?
Mr Mark Drakeford: I think my recollection of the time is that the powers were more about allowing resources that were already there to be deployed more effectively. I’m not saying for a moment that there was no case for additional resources, but the primary case was: you have a resource, the powers that they need are not in the right place, when those powers are transferred, those people who are there already would be able to do their job more effectively.
Lead Inquiry: Finally, in relation to the structure, there was a pre-existing civil contingencies structure in Wales, of course, and as we will see later in the course of your evidence it had many moving parts. To what extent did the Welsh Government seek to recalibrate that structure, to make sure that the structure was in the best place possible to start carrying out the new functions which the Transfer of Functions Order permitted them to do so?
Mr Mark Drakeford: Well, ministerially, because that’s the perspective from which I was able to view it, the structures were sufficient to make sure advice flowed to ministers, flowed in a timely way, was enabled to raise issues with ministers when those issues were required. And in some ways – you don’t spend your time looking at the wiring diagram so long as you are confident that the diagram produces the result that you need, consistent advice of the quality that you require, in a timely fashion, and I felt confident that the system did do that.
Lead Inquiry: Beyond – I don’t mean this pejoratively – beyond the parochial issue of what advice individual ministers and the First Minister was receiving, to what extent did the Welsh Government stand back and say, “Is this structure for civil contingencies emergency preparedness the correct structure to be able to deal with the future discharge of these additional powers?”
Mr Mark Drakeford: Yes.
Lead Inquiry: The evidence is quite plain that there are a lot of different bodies in the Welsh civil contingency field. Were they the right bodies in the right place to be able to deal with these new functions?
Mr Mark Drakeford: Well, my predecessor as First Minister ordered a review of those structures to accompany the transfer of functions. So there was a conscious effort to make sure that the Welsh Government would be equipped in that structural sense to use the new powers that came its way.
Lead Inquiry: There was, and my Lady has heard evidence to this effect, a report on civil emergencies in Wales dated 6 December 2012. There is absolutely no reason why you would have had to have had that brought to your attention when you became First Minister or even Health Minister, because it was before your tenure as Health Minister. But the evidence yesterday and in part today is that that report in 2012 highlighted the fact that there were too many bodies, too many groups in the civil contingency system in Wales, that there was a complex resilience framework, problems with inefficiency and effectiveness, as well as there being no common approach to risk assessment and a number of other important matters.
Do you know whether or not following that report in 2012, six years before the Transfer of Functions Order, there was any rationalisation of the groups or the structures?
Mr Mark Drakeford: Well, I’ve given this some thought, having heard it raised with previous witnesses. From the perspective of the Minister, the system did not look particularly complex. You know, there was – I think it’s to be found in the Pan-Wales Response Plan, on a single page, the essence of the structure.
Once the structure moves into the particularities of, you know, professional roles and perspectives, it does sometimes enter a rather arcane world that is only really understood by those that are part of it.
But as a Minister, what I needed to know was: how would advice get to me, which levels would it have passed through, am I confident that that means that the advice that comes on to my desk has been tested, has the necessary expertise. And I didn’t feel that complexity was a barrier to that happening.
Lead Inquiry: We’re going to try to find that diagram, Mr Drakeford, if we can.
Mr Mark Drakeford: Page 9.
Lead Inquiry: I think it’s the Pan-Wales Response Plan, INQ000107119.
Mr Mark Drakeford: You can find it on page 9, and page 11 goes alongside it.
Lead Inquiry: Thank you.
Yes, so there is the flowchart which deals, in fact, with a slightly different issue, which is the levels of contingency or emergency, because in the event of a level 2, the civil contingencies group is required to establish a Wales civil contingencies committee.
So I think what you have in mind is perhaps rather more page 11, which is a concentric chart – no, that’s again dealing with levels 1, 2 and 3.
We will see if we can find it, but I think you have in mind there is a concentric chart which sets out the local resilience forums, the strategic co-ordinating groups, the various external bodies and then those parts of the Welsh Government on top.
Mr Mark Drakeford: But essentially, from a Minister’s point of view, provided all of that is effectively translated into the actions that you would need to take in face of an emergency, as set out on pages 9 and 11, then you have confidence to know that the system, when called upon, whatever complexity might lie behind it, the system when called upon will operate in that comprehensible way.
Lead Inquiry: Would you nevertheless agree that, following the 2012 civil emergencies report, the audit office report on civil emergencies in Wales, and between that time and 2018, there was no wholesale change or no significant change to the civil contingencies structure in Wales?
Mr Mark Drakeford: Yeah, I think that will be fair.
Lead Inquiry: All right.
In May 2018, exactly concurrent in fact to the Transfer of Functions Order, there was a report of Internal Audit Services called Audit Services’ Emergency Planning, Preparedness and Response , INQ000128972, which was concerned with the assurance rating of the emergency planning preparedness and response system. So it’s a report by Internal Audit Services within the Welsh Government.
If you look at the top half of the page, you will see an overarching general assurance rating given to the system of emergency planning, preparedness and response, and quite evidently, Mr Drakeford, all parts of the Welsh Government are subject to audit at some level and from time to time, and this is the audit on emergency planning, preparedness and response.
The assurance rating is given as reasonable. If you take it from me that that was a reduction in the rating from the earlier rating, which was substantial, that it had received eight years before in 2010, were you aware that at the time that the functions were being transferred to the Welsh Government, the assurance rating for the Welsh Government’s emergency planning system had been downgraded one slot, one mark?
Mr Mark Drakeford: I don’t think that I would have known it in those terms. What I would have been aware of was advice that suggested that the level of threat over that period had grown, so that the system itself may have been as it was in 2012, but now it’s having to deal with different threats and more significant threats.
Lead Inquiry: There are references in this report to prospective obligations which would have to be placed on the First Minister of Wales. You weren’t First Minister then, you became so in December of 2018, but if you could have page 3, paragraphs 1.3 through to 1.6 – page 3, 1.3 to 1.6 – and perhaps picking up the thread at 1.5:
“Following a Wales Audit Report in 2012, the First Minister has agreed to the transfer of executive functions … This is likely to take place by June 2018 … This … give[s] Welsh Ministers brand new powers to exercise additional functions including:
“- Issuing guidance …
“- monitoring devolved responders and requiring them to produce information …
“- bringing enforcement proceedings …”
Then if we could just run through, please, to page 5 at paragraph 3.7, so we can see the overarching scheme:
“Resource requirements have been identified by the Resilience Team to be able to carry out the new duties and activities required to support Ministers’ responsibilities.”
There is a reference then to the then First Minister writing to the United Kingdom Government looking for money.
In broad terms, Mr Drakeford, following that audit report, which had noted that the rating had reduced itself from substantial to reasonable, was there a wholesale rewriting of guidance? Were, in a general sense, the Welsh Government’s pandemic plans and civil contingencies plans rewritten? Were there or was there put into place a new system or an enhanced system of monitoring devolved responders and possibly bringing enforcement proceedings?
Mr Mark Drakeford: The system didn’t have a wholesale change, and the review that my predecessor set in motion in 2016 concluded that wholesale change was not required. There were adaptions and modifications but the system did not need a root and branch rewriting in the terms that you put it.
As you know, the powers that came with the Transfer of Functions Order were not exercised immediately.
Lead Inquiry: On a related issue, the Welsh Government had never produced its own self-standing risk assessment process or risk assessment document setting out all the risks facing the Welsh Government in the same way that the United Kingdom Government did in London and we’re aware that the Scottish Government did in Scotland.
Do you recall whether at this time of great change consideration was given to the production and publication for the first time of a Welsh-centric risk assessment process?
Mr Mark Drakeford: I don’t think I could say to you I remember a specific discussion of that sort. I remember the general discussion, which is that for certain purposes it is sensible from a Welsh perspective to lie on – to rely on the expertise and the capacity that the UK Government has, and we were content at this point to do so.
I’m not sure we would have felt that there was a huge advantage to be gained from deducing Welsh-specific risks when the United Kingdom Government’s risk assessment process appeared to us to be one that you could rely on and had the expertise it required to deliver it.
Lead Inquiry: You are, of course, familiar with the doctrine that all risk is local, the subsidiarity principle, you’ve no doubt seen the evidence about how, in the civil contingencies field, the principle of subsidiarity is applied. There will no doubt be risks, won’t there, which will affect Wales differently? There may even be risks which would only affect Wales. But to rely upon the United Kingdom risk register for risks identified by UK officials to apply across the board tended, did it not, to fail to give sufficient consideration to Welsh-specific risks and how they might be managed?
Mr Mark Drakeford: Well, the way that that was discharged was through the four LRFs, so I agree with you that you needed a local application of the national register. Whether there is a Welsh intermediate tier for that was something we did not feel at that time would have justified the resources that would have been required to develop it. But we did ensure that at the four LRF levels there was a statutory obligation to produce a community risk register. So if I might just give you one example, the National Risk Register no doubt had things in it about what would happen in the event of an explosion at an oil refinery. Now, in the Dyfed-Powys part of Wales, that’s a significant concern, given that there is a concentration of oil refineries. In the north of Wales that wouldn’t be a very high consideration there being no oil refineries actually across the North Wales coast.
So the way in which we discharged the obligation, which I agree with is an important one, to localise and particularise the National Risk Register, was not at a Wales level but at the level of the four LRFs.
Lead Inquiry: That’s exactly the point, isn’t it, that the risk assessments were looked at solely in the context, at least formally on paper, of the four local resilience forums. There was no formal process by which the national Welsh Government could identify a risk in relation to which it may have to step in to deal with alongside the local resilience forum, the strategic co-ordinating group, and whatever regional partnership there might be?
Mr Mark Drakeford: I think you will find that in the – and I’ve heard you used the word “labyrinthine” – structures that exist, actually there is a group which is chaired by the Welsh Government which brings the four LRF risk assessors together for this purpose. So while it’s discharged at the LRF level, the Welsh Government is not in ignorance of the way that those community risk assessments are being produced because there is a coming together of the four LRFs under the chairing of a Welsh Government official in order to collect that back at an all Wales – from an all Wales perspective.
Lead Inquiry: There is a Wales Resilience Forum at which such issues are debated?
Mr Mark Drakeford: Indeed.
Lead Inquiry: My point, though, Mr Drakeford, was concerned with the system of risk assessment. There is no process by which, formally, the Welsh Government gets to analyse the risks which its country faces – which may have to be responded to not just by local resilience forums but by the Welsh Government itself – in the way that there is for Scotland and for England?
Mr Mark Drakeford: No, for those purposes, we used the UK-wide risk assessment process.
Lead Inquiry: All right.
In October of 2018, at one of the meetings of that exact same body, the Wales Resilience Forum, Mr Drakeford, the then Cabinet Secretary for local government and public services agreed that a review of emergency planning governance and structures was required, I think, in order to ensure whether they were “fit for purpose”.
You agreed, as First Minister – because by December you had become the First Minister – you had agreed that a comprehensive review should be undertaken which would develop a platform to support the new regulations.
So the answer, perhaps, to one of my earlier questions was that there was a recognition by you, on behalf of the Welsh Government but by you personally, that it was important to carry out a review to make sure that the system could cope with that transfer of powers?
Mr Mark Drakeford: I think I said, apologies if I glossed over it in an earlier answer, that my predecessor, on agreeing the transfer of functions, had initiated that review.
Now, by the time it came to make its way into sort of formal sign-offs, it had probably been overtaken by my arrival. But the initiation of it pre-dated my becoming First Minister.
Lead Inquiry: We believe that following that Wales Resilience Forum meeting, which didn’t take place until October 2018, the matter formally did go to you as First Minister and you agreed that that review was necessary.
The review didn’t, however, take place, did it, until 2023?
Mr Mark Drakeford: No.
Lead Inquiry: So that we can understand the chronology, it took the best part of 2018 for that review process to be initiated. The review was then hampered by the diversion of resources to what is now, by way of a familiar refrain, the necessary preparations for a no-deal EU exit, and then of course, after that, Covid.
Is it a matter of some regret that that review, which was obviously important, otherwise you wouldn’t have ordered it, was not in the event able to be brought to fruition, and was not brought to fruition for a matter of years, there being at least 18 months from October 2018 to March 2020?
Mr Mark Drakeford: Well, of course it was a matter of considerable disappointment to us, because the Welsh Government had, as you said, worked hard to secure the transfer of those responsibilities, and to make sure that we were in a proper position to discharge them.
But by the time I became First Minister, I chaired my first Cabinet I think four days after becoming First Minister, and almost the whole of that Cabinet meeting is devoted to preparations for leaving the European Union without a deal. So by the time I became First Minister, the system was already turning its sights very firmly to a danger that was right in front of you and of very significant potential consequence.
Lead Inquiry: May we have, please, then that review, INQ000187580, please, of 2023.
There is the Review of Civil Contingencies in Wales. It says across it, or at least on the copy that we have, Mr Drakeford, in stern terms “Not government policy”. We have been collectively a little troubled by that. This is a review of civil contingencies in Wales ordered by the Welsh Government in part but jointly owned by a number of other organisations. Why is it necessary – or why does it say “Not government policy”? Is that because you haven’t yet formally decided whether or not to give effect to its recommendations?
Mr Mark Drakeford: Well, I am imagining, rather than being certain on the specifics, but this would be the normal way of things happening in Wales. The document would be produced, we would wish the views of partners to be received on it, there may be, you know, aspects of it that the fire service, for example, to take just one example, might wish to draw to our attention. So while we would circulate the document to make sure that anybody with an interest can contribute to the final version, we make it clear to people that it’s not, at that stage, formally adopted as government policy.
Lead Inquiry: If we turn to page 33, please, we’ll find the recommendations, priorities and next steps.
The first one is a national assurance framework for Wales to be developed with monitoring to be managed by the Wales Resilience Board. So in fact a new body, not the Wales Resilience Forum but the Wales Resilience Board. In the right-hand column the authors of this worthy document state that this is a matter that is “Critical”.
If we just go forward to page 35 we will see what is meant by critical, although it may be thought self-evident. There we are:
“Critical (Do Now) – it is of the greatest importance that action is taken immediately.”
So going back to page 33, may we take it, Mr Drakeford, that the authors of this report regarded the absence of a national assurance framework for Wales, that is to say a system by which all the moving parts in the Welsh civil contingencies structure could be tested to make sure they were up to scratch, was a matter of the very greatest concern to which it was essential that action be taken right away?
Mr Mark Drakeford: Well, it is self-evidently the views of the authors that this is their most important recommendation. My own view would be that, nevertheless, that recommendation has to be tested by others, given that its implementation will rely upon the willingness of others to make that contribution. So no doubt this will make its way to my desk with final proposals and they may not look identical to the ones that we see in front of us this afternoon.
Lead Inquiry: The civil service in Wales will of course present this to you along with their own views and no doubt seek a decision from you.
Number 2, risk, we were just debating this very issue a few moments ago:
“[The Welsh Government] and [the local resilience forums] should work in partnership to interpret the UK National Risk Register and adapt UK level risks to Wales … to identify upcoming and potential risks that would significantly impact Wales …
“Essential.”
Does that go directly to the heart of the issue that we were debating a few moments ago: the need for a Welsh Government level input into the identification, management, ownership of Welsh risks?
Mr Mark Drakeford: Yes, it does. I was careful in answering your earlier questions to try to be clear that the view that the UK risk register was adequate for the purpose was a view of that time. I was aware, because I’ve been involved in some discussions, through the resilience forum, that contemporary thinking is that that intermediate Welsh level may need strengthening, and you see that in this recommendation.
Lead Inquiry: On page 34, at number 13:
“Regional risk assessment should be used to define a regional training and exercise regime to address Wales-wide capability gaps or development needs.”
Then over the page at 15, page 35, “centrally managed training and exercise regime”.
Now, plainly many of these recommendations must have been formed as a result of the terrible experience of Covid, but to the extent that they identify significant changes in the Welsh structure for civil contingencies, training, assurance, formal process of risk assessment, does this not rather indicate that there were pre-existing structural flaws in the civil contingencies system in Wales, that is to say even before Covid?
Mr Mark Drakeford: I think I probably have two observations to make there. First of all, I wouldn’t necessarily interpret the fact that a document says that skills and professional development is needed as meaning that that didn’t exist previously.
Lead Inquiry: Agreed.
Mr Mark Drakeford: I think it is just a statement of the ongoing need to make sure that that is part of the system. And I don’t think myself you can necessarily conclude that because, in the light of new powers, changed circumstances, that a report says that that now needs to be reflected in new and strengthened systems, that that says that prior to those things the system that was there was not fit for the purposes which, at that time, were there to be discharged.
Lead Inquiry: But, Mr Drakeford, the premise of that answer was that this is recommending new and improved systems. Insofar as the report recommended a national assurance framework, a Welsh Government risk assessment procedure, a provision of centrally managed training and exercise, those were not improvements, they are standalone and completely novel developments. They simply have never existed hitherto.
Mr Mark Drakeford: And they reflect the report authors’ view of what is needed in Wales in 2023 rather than their reflection of what was needed in 2018. I think that’s the only point I’m making, is that it is reflecting today’s Wales, today’s circumstances, today’s challenges.
Lead Inquiry: But these were challenges, of course, which have come into focus as a result of Covid, but in terms of the structural performance of the civil contingencies structure in Wales, these are not new issues. The United Kingdom – the London government had put into position over many years a system for national assurance, for National Resilience Standards – my Lady heard evidence about the production of three different versions of those National Resilience Standards – a national resilience academy, a structure for training and exercising; they’re all part and parcel of civil contingencies, are they not?
Mr Mark Drakeford: And the capacity to offer training and a number of those things existed right through the system. They are restated here in the contemporary circumstances.
Lead Inquiry: All right.
Risk registers. You’ll know from the paperwork which we have provided you with that there were in existence corporate risk registers for the Welsh Government.
Please may we have up the first one, which is an issue which is January 2016, INQ000215556, page 1, column P5 – or entry P5, row P5:
“Resilience (Major Emergencies):
“If we fail to provide leadership and co-ordination in ensuring Wales is prepared for and resilient to the full range of national hazards and threats which is faces then there is a risk to the health and well-being of its citizens.”
A self-evident risk one might think.
There are then a list of controls identified as being the risk control measures or proposed mitigating actions, and if we could just go over the page, please, we will see the rubric, the notes which go with that – those scores, and explain what they all are.
If you go back, please, to page 1, there is, it appears, in this risk register, very little by way of specific identification of what the emergency that is pandemic influenza might consist of or the specific controls or countermeasures for pandemic influenza as opposed to major emergencies, civil contingencies, major events and so on.
Would you agree, Mr Drakeford?
Mr Mark Drakeford: I think that is – that’s a fair summary of what we see in front of us.
Lead Inquiry: If we then have a look at June 2019, INQ000215558, which is a single-page document – and on this occasion please feel free to scroll in, the reference to risk description, disruption event affecting people, places, finances, communications and IT. If there is a significant disruption event the Welsh Government may struggle to recover its operations quickly and effectively. Then a number of mitigation measures, control measures, by way of business continuity plan, disaster recovery arrangements, lessons are learned, emergency response protocols.
Dr Goodall, the permanent secretary to the Welsh Government, from whom we heard yesterday and today, acknowledged that, insofar as those measured purported to reduce the risk of disruption events, whilst worthy on their own – in their own terms, they did not actually reflect the reality of the position on the ground, insofar as, although there were a multitude of plans, civil contingency, public health emergency, pandemic influenza plans, they had not been updated, and in the majority had not been updated since 2014, the disaster recovery arrangements were undermined by the fact that a significant number of recommendations from earlier exercises had not been implemented, lessons had not been fully learned from disruption events, and emergency response protocols, whilst the subject of some training and exercising, had not been scrutinised to the full.
Would you agree, therefore, that insofar as the Welsh Government sought to properly understand the risk of pandemic influenza, it went awry by virtue of relying upon mitigation measures which turned out not to be wholly accurate?
Mr Mark Drakeford: Well, as far as the two documents that I’ve just seen are concerned, I think Dr Goodall is a more effective witness than I can be. Ministers are not responsible for the corporate risk register. I would expect it to be used by senior officials to draw the attention of ministers to areas where senior officials believe ministerial intervention would be necessary, but ministers do not routinely see and are certainly not directly responsible for the material that lies behind them. So Dr Goodall’s evidence to you would be more useful to you, I think, than my own.
Lead Inquiry: All right.
Could you give us, then, some indication of the frequency with which the issue of the Tier 1 risk of a pandemic influenza was brought to the specific attention of the First Minister.
You were, as First Minister, ex officio the chair of the Wales Resilience Forum, and it’s obvious that there are a number of Welsh Government documents in place. But how often was pandemic preparedness brought to you specifically as a priority worthy of your attention?
Mr Mark Drakeford: I wonder if I could just make one general point.
Lead Inquiry: Please.
Mr Mark Drakeford: Which is that I have struggled a little in reading documents again for today to distinguish between things which I am learning as a result of preparation and things that I actually knew at the time, and I do not want to imply to you that because I know things now I necessarily knew them then.
Lead Inquiry: Of course.
Mr Mark Drakeford: So that is a line I’ve not always found it easy to completely walk down.
But I think I should probably say that, of course, by the time I’d become First Minister I have been, as you have said, engaged in the Welsh Government for – well, since the very start of devolution, and have lived through a whole series of emergencies, and having been the health minister particularly, I am maybe more alert to the risk of an influenza pandemic than I otherwise would have been.
So I am –
Lead Inquiry: Because of those emergencies that you had to deal with de facto?
Mr Mark Drakeford: Yeah, the history of being in the Welsh Government is constantly dealing with one sort of civic emergency or another. During the time that I was the Health Minister, for example, as well as the measles epidemic I was dealing with officials with a TB outbreak in the town of Llanelli, the Ebola outbreak happened while I was the Health Minister, and that is, you know, completely beyond things like flooding, coal tip safety, cyber security incidents and all the other emergencies that you have to get drawn into.
By the time I became First Minister I was, therefore, aware, but I think as much because of the background of the fact that there was a Tier 1 risk and that pandemic influenza was and had been over many years repeatedly identified as the most likely risk to face the United Kingdom.
Lead Inquiry: In his witness statement to this Inquiry, Mr Gething said, as far as he could recall, preparedness was not a particular focus of interest or concern in the government, the Senedd or outside; but he became aware of it by virtue of his personal involvement in Exercise Cygnus.
Regardless of your own plainly established personal involvement as First Minister in the field of civil emergencies and including health emergencies, can you recall to what extent the civil servants brought to you or to your fellow ministers concerns about the state of preparedness for pandemic influenza?
Mr Mark Drakeford: Well, in my recollection it would almost always have been in the context of exercises that were carried out. So the 2014 Cygnus exercise happened when I was the Health Minister. That was, of course, the Welsh-only exercise.
Lead Inquiry: Yes.
Mr Mark Drakeford: So while I share the same identical experience as Mr Gething, I don’t think I was ever asked a single question on the floor of the Senedd or in any media interview on preparedness per se. That did not mean that when exercises took place and conclusions were being drawn from them that your attention as a minister was not drawn to them.
Lead Inquiry: In your witness statement for this Inquiry you say:
“I became First Minister in 2018 [that’s obviously December 2018]. I do not recall any advice from officials that there were reservations about the state of Wales’ pandemic preparedness, nor did I recall any concerns in the Senedd being raised with me.”
May we take it from that that none of the issues that we’ve so far debated, the civil contingencies report of 2012, the issues about putting the recommendations from that into place, or, as you rightly observe, the outcome of Exercise Cygnus, the Wales-specific part of it in 2014 or the UK part of it in 2016, or exercise – and the name has now completely escaped me – Talie …
Mr Mark Drakeford: Taliesin?
Lead Inquiry: Taliesin, I’m very grateful, Mr Drakeford.
None of those specific issues, we may take it, were brought to your attention because they all preceded, of course, you becoming First Minister, and if you never received advice or you can’t recall advice about reservations and the state of pandemic preparedness, it must follow that none of those specific matters were brought to your attention?
Mr Mark Drakeford: Not at the point that I became First Minister, but, as I’ve tried to indicate, I would have been aware of them, having been involved in those events throughout that period.
Lead Inquiry: But your own personal knowledge of the state of affairs or the state of play of the civil contingencies system can’t be translated into executive action on the part of the government or a determined attempt to try to improve the position, that’s not within your capability, is it? You may have known of problems or flaws in the system, but unless the government around you identifies those flaws and determines it will act upon them, nothing is likely to be done, is it?
Mr Mark Drakeford: So just to try and make myself plainer, if I can: by the time I’ve become First Minister I’m not unaware of the issues that have been faced by the Welsh Government or the exercise in which the Welsh Government has been involved. When I become First Minister I do not receive advice from the civil service that says, “You need to be particularly aware of difficulties that we are now experiencing in these fields”.
Lead Inquiry: Thank you.
We have heard something of task and finish committees being instituted in order to ensure that recommendations from exercises and outbreaks are learnt. Following swine flu, the Wales Resilience Partnership Team agreed to set up the Wales pandemic flu task and finish group to consider recommendations from the 2009 swine flu pandemic.
Were you aware that that committee was unable to finish its task because the recommendations were not all fully implemented?
Mr Mark Drakeford: I could not say that I was – that I recollect being aware of that specific issue.
Lead Inquiry: All right. There was a review in 2013 called the Pollock review which investigated ironically why lessons weren’t being learned, and as a result of that review the Wales Learning and Development Group was formed, and a decision was taken to apply something called Joint Organisational Learning strategy.
But then Exercise Cygnus came along, both in 2014 and 2016, and the Wales Resilience Partnership Team delegated the responsibility of implementing recommendations to yet another body, the Wales Pandemic Flu Preparedness Group.
That group met in September 2017, but didn’t meet again after January 2018. Were you aware when you became First Minister in December 2018 that that primary group for the implementation of the recommendations from Cygnus, whilst sitting in September 2017, never sat after January 2018?
Mr Mark Drakeford: I’d want to check my own recollection, but I actually believe it met in as late as October of that year.
Lead Inquiry: October 2018?
Mr Mark Drakeford: 2018, yes, I believe that was the final meeting before its resources were directed into the no-deal Brexit exercise, rather than the January.
Lead Inquiry: All right. Well, we’ll double-check that, of course.
Mr Mark Drakeford: Thank you.
Lead Inquiry: But the point remains, doesn’t it, that the workstreams which were identified after Exercise Cygnus in 2016 were not all fully implemented because the body designed to ensure implementation, the Wales Pandemic Flu Preparedness Group, didn’t sit – we’ll agree to disagree whether it was after January or October 2018 – because of the impact of the no-deal EU exit planning?
Mr Mark Drakeford: Yes, I think the expert report that the committee – that the Inquiry has says that devolved administrations did pursue pandemic preparedness, and that in Wales it went on for two years after the Cygnus conclusions were reached, but you reach a point at which we are diverting resources across the whole of the Welsh Government into dealing with the dangers that are sitting right in front of us of leaving the European Union without a deal.
Lead Inquiry: But obviously this Inquiry is concerned exclusively with civil contingency emergency preparedness; from that standpoint, those recommendations were never fully implemented?
Mr Mark Drakeford: That is without doubt. I simply make the point that government is never exclusively concerned with any one strand in the many challenges that it has in front of it.
Lead Inquiry: Indeed.
Mr Mark Drakeford: You can’t understand the way the government responds unless you are aware of the context within which it is responding.
Lead Inquiry: Pandemic preparedness is self-evidently a matter of life and death, is it not?
Mr Mark Drakeford: Yes.
Lead Inquiry: To what extent was that terrible balance identified between focusing upon the life and death consequences of pandemic preparedness and the consequences of failing to prepare for a no-deal EU exit?
Mr Mark Drakeford: Apologies if this answer is slightly longer than some of the ones I’ve tried to give.
So at the point when the UK Government decides to institute Operation Yellowhammer and we are now facing the reality of leaving the European Union without a deal, with all the consequences that that would have had for Wales, I am making a decision, along with my colleagues, to divert resources to deal with that.
The number of people we have in the Welsh Government who have genuine expertise in civil contingency matters is relatively modest, and their skills are particularly relevant to preparing for leaving the European Union without a deal. To give you just one example, Wales has reservoirs that serve not simply the Welsh population, but the whole of Birmingham and the whole of the northwest of England. The chemicals that you rely on to make that water safe to drink come from Germany, and while we were a member of the European Union they came without hindrance and they came on an “as they were needed” basis. We faced a real risk that if we left the European Union without a deal, that water supply would no longer be usable. That is the sort of present danger that you are talking about. It is absolutely real, would be immediate, and would have absolutely direct results on the lives of people.
Who do we look to in the Welsh Government to help us to find a way through that if we need to? Well, some of those people would need to be people who had the expertise in preparing and thinking about, and indeed, in the Welsh context, practically responding to the other emergencies we had already faced.
Lead Inquiry: To what extent was that balance brought to your attention, Mr Drakeford? And the point that you make is, if I may say so, very well made. You were faced with present and immediate risks, which of course you had to address. But it’s in the way of government, isn’t it, that you get on with addressing the job in hand? To what extent were you aware that that necessarily was diverting resources away from other less present but perhaps more catastrophic risks? Was it an issue on which they sought your advice?
Mr Mark Drakeford: I am very consciously aware of it, and I am consistently aware of it because I’m forever having to disappoint my colleagues, who have ambitions in their own portfolio areas, pieces of legislation that they are committed to bringing forward, for example, and my job is to explain to them why that will now not be possible. I’d do that, you know, month after month, throughout the whole of 2019, always to their disappointment.
So yes, the diversion of resources from other priorities to dealing with leaving the European Union without an agreement, it’s a very conscious set of decisions, and constantly debated as well, as to whether we are getting that balance right.
Lead Inquiry: May we take it from that answer, Mr Drakeford, that you were, therefore, aware of the consequential impact upon pandemic preparedness because of the necessary diversion of resources, that it was an area that was brought to your attention and in relation to which you were forced into the Hobson’s choice, perhaps, of saying, “That area can no longer be resourced and it simply cannot be the subject of focus because of this other greater risk that we face”?
Mr Mark Drakeford: Well, it cannot be resourced to the extent that it previously was being resourced. It’s not the case that you rob everything away from it. Work does continue even beyond the end of December 2018, but you’ve had to reduce the resource in order to deal with something that is immediate and pressing and potentially catastrophic in its impact if you’re not able to deal with it.
Lady Hallett: Mr Keith, forgive my interrupting. How are we doing for time? Because obviously we need a break.
Mr Keith: It’s a very convenient point.
Lady Hallett: We are determined to complete your evidence today, Mr Drakeford, don’t panic.
The Witness: Thank you.
Lady Hallett: So I shall return at 4.10, just a five-minute break.
(4.05 pm)
(A short break)
(4.10 pm)
Mr Keith: Mr Drakeford, turning to the question of guidance and strategies and plans, you are of course aware that the United Kingdom 2011 document, the influenza preparedness strategy, formed the genesis for all the civil contingency and major infectious disease pandemic related documentation in Wales, and therefore was similarly tainted – they were all similarly tainted by the same doctrinal or strategic flaws, as my Lady finds them to be. What was sauce for the goose was sauce for the gander doctrinally for all that material, wasn’t it?
Mr Mark Drakeford: The plan was an inadequate basis for dealing with the events that subsequently unfolded, but not wholly inadequate. There were aspects of it which were still useful, but it clearly did not stand up to its major test.
Lead Inquiry: It went beyond that, though, didn’t it, because there was a complete failure to address issues such as the inherent characteristics of respiratory viruses, the consequences of differing incubation periods, differing transmission rates, differing viral loads and so on, and of course all the associated countermeasures which might prove to be necessary to deal with such a virus; all that was absent?
Mr Mark Drakeford: All of that is absent, and there are other aspects that the plan turned out not to have grappled with adequately either.
Lead Inquiry: Yes. The Pan-Wales Response Plan of 2019, even by 2019, was tainted by the same doctrinal flaws. It doesn’t itself or didn’t itself in fact contain much in it by reference to pandemic planning, because although there was a section on terrorism and the threat of terrorism, there was no analogous section on influenza pandemic, was there?
Mr Mark Drakeford: It is a generic document intended to cover the range of potential emergencies that might be faced in Wales, so in that sense it doesn’t operate at that level of specificity, that is true.
Lead Inquiry: So in summary, Mr Drakeford, by the onset of the pandemic in January 2020, the government – not you personally but the government – had failed to address many of the problems identified in the Wales audit office report of 2012 in relation to the complexity of the Resilience Framework, problems with inefficiency and ineffectiveness, doubts over the availability and maintenance of physical assets in human resources.
It had failed to implement all the recommendations from Exercise Taliesin and the two Cygnus exercises. There hadn’t been any significant recalibration of the structural system following the Transfer of Functions Order. None of the pandemic or disease outbreak or civil contingency paperwork that mattered had been updated. Then, of course, materially some of the final workstreams arising from the Wales Pandemic Flu Preparedness Group were blown off course by the preparations for a no-deal EU exit.
So, in the round, would you agree that there were and there continued to be significant failings over that eight-year period?
Mr Mark Drakeford: There’s no doubt at all that there were failings. I think the way that you set them out would, to my mind, give an unduly bleak account of some of the things that had happened over that period. So while some things had failed to be followed through, it was a failure in part rather than in whole.
When you say that the system had not taken the lessons in terms of effectiveness, in fact the system was very, very regularly tested in reality, including to a very major extent in February of 2020, and demonstrated that it was very effective in dealing with real life civil emergencies in Wales.
So while I don’t dissent at all from your general conclusion that there were things that ought to have been done and could have been done that hadn’t been done, I think to describe it entirely in those terms is to overlook some of the things that positively had happened and the successful way in which the system in Wales demonstrated its ability to respond when real emergencies arose.
Lead Inquiry: Let me make it absolutely plain, Mr Drakeford, it forms no part of this examination to question the remarkable individual response, of course, from all those who responded in the face of the pandemic, and of course it’s quite plain that the Welsh Government was able to, in material regard, respond efficiently to the terrible demands made on it. But the fact that it was able to respond is neither here nor there in terms of the consideration of whether or not structurally the system of preparedness, in advance of the pandemic, was simply not as good as it should have been and therefore the Welsh Government was not as prepared as it could have been. Would you agree?
Mr Mark Drakeford: Put like that, I would agree, yes.
Lead Inquiry: Right.
Could I now ask you, please, some questions about links to the United Kingdom at a ministerial and medical level.
The Hine review in July 2010 made a multitude of recommendations about how health ministers should meet pan UK in order to address matters of mutual concern.
Was it your experience that at that level, the health minister level, the relations between Wales and the Westminster government worked well?
Mr Mark Drakeford: No, I wouldn’t characterise them as working well. What they –
Lead Inquiry: Why not?
Mr Mark Drakeford: – lacked was a systematic basis for engagement, and this has long been my complaint about intergovernmental relations in the United Kingdom, that they rely far too often on individual willingness to work in that way, whereas what you need is a robust system of machinery of government that brings people to the table for common purposes, whether individuals are so inclined or not.
Lead Inquiry: You’ve referred then expressly to ministers. I was actually asking you about at the health level. Does what you say apply, therefore, to all forms of Welsh ministers, so the First Minister, health ministers and other ministers, or does it also apply to the health official level, so, for example, relations between the Chief Medical Officers?
Mr Mark Drakeford: At official level, much work goes on day in, day out in a perfectly orderly and engaged way, and I think you’ve got good examples in the way the Chief Medical Officers at that top of the profession level worked together as well. I was trying to explain my long-held view that the United Kingdom lacks, at that ministerial intergovernmental level, a sufficiently robust, reliable, regular pattern of engagement that does not rely on the individual predilections of particular players either to become engaged or not to become engaged.
Lead Inquiry: In effect, a system that doesn’t rely on ministerial whim as to whether or not a meeting will take place at all?
Mr Mark Drakeford: Well, I would give you a good example, if I could. When I became the Finance Minister, I took a telephone call at his initiative from the Chancellor of the Exchequer, Philip Hammond at the time. We agreed that day-to-day the relationships will be between myself and the Chief Secretary to the Treasury, but he made it clear in that call that at any point if I needed to speak directly to him about an issue, he would always be available to take that call.
That is a good example of where a particular minister with a predilection to co-operate in that way made it clear that he wanted to do so. The system ought not to rely on individual willingness of that sort.
Lead Inquiry: There is evidence to suggest that consideration was given at some stage to the setting up of a health ministers forum to provide a structure of the type that you’ve described. Do you know why that never came to pass?
Mr Mark Drakeford: Well, there is a JMC mechanism, a joint ministerial committee mechanism. It operated very well in certain contexts, it didn’t operate at all in others. It didn’t operate in the Health context and during the time that I was the Health Minister in Wales. While we enjoyed, I would say, very good relationships with Jane Ellison, who was a Conservative minister in charge of public health and who led the Ebola response, that was absent at the level of the Secretary of State.
Lead Inquiry: The JMC system has always existed, and it may or may not operate effectively depending on perhaps the whim of the contributors, but I am asking about a particular body, a health ministers forum, which was debated after the Hine review in 2010. Do you know what became of those proposals or why nothing in practice was done?
Mr Mark Drakeford: I would say there was no appetite on the part of UK Government ministers to establish such a forum. The initiative lies with them in a JMC context.
Lead Inquiry: Right. So it wasn’t a lack of initiative on the Welsh part; the problem lay on the UK side, you believe?
Mr Mark Drakeford: Under the JMC mechanism, the initiative lies in the hands of UK ministers.
Lead Inquiry: There has since been a review of intergovernmental relations, it took place in 2022. I think it was commissioned in 2018, so it didn’t proceed terribly quickly. Do you know whether or not, as First Minister, there have been any meetings of the interministerial group or the standing committee or the secretariat for which that new process provides?
Mr Mark Drakeford: It is a three tiered structure.
Its pinnacle is a council of ministers, that’s the First Ministers and the Prime Minister. It has met once, but not in full form because there has not been a First Minister of the Northern Ireland Executive since the agreement was struck, but the current Prime Minister, Mr Sunak, has presided over one meeting of the council.
The intermediate tier has the F:ISC, the finance interministerial committee, that does meet regularly, and then it has another standing committee that has met more intermittently.
Then at the third tier there will be the sort of meeting between specific portfolio ministers, health ministers for example could be one. I myself do not believe that that tier has operated in the way that the intergovernmental review mechanism anticipated. It has been at best hit and miss.
Lady Hallett: Is that because health is such a party political issue? Why do you think, Mr Drakeford?
Mr Mark Drakeford: It will be wider than health, and my own view is, is that where there were pre-existing relationships, they have continued. So there’s always been a strong interministerial group around farming and environment and rural affairs, and that has continued to meet under the new regime and to do so regularly. Where there is no history of engagement of that sort, the new machinery has not succeeded in sparking those arrangements into life.
So I don’t think it’s particularly to do with health or the politically contested nature of health. I think there’s no history of it in health, and as in other parts of Whitehall where there is no history, the new intergovernmental arrangements haven’t succeeded in generating new forms of interaction.
Mr Keith: It does appear, however, to be an improvement on what went before?
Mr Mark Drakeford: It is systematic, it has an independent secretariat, it has an independent means of resolving disputes. All of those are improvements. I was glad to be able to sign the document.
Lead Inquiry: Good.
There is also, in the field of resilience, a new forum, the UK Resilience Forum, in relation to which the Deputy Prime Minister Oliver Dowden gave evidence now some time ago. There have been three meetings of that UK Resilience Forum. The Welsh Government attended the first one in July 2021 and it attended the third one in February 2023, but was absent with apologies from the May 2022 meeting. Do you happen to know why, unusually, the Welsh Government, given the attendance of other entities, absented itself from that meeting?
Mr Mark Drakeford: I think it’s important to say that while it is ministerially chaired, that forum, it is not a ministerial meeting.
Lead Inquiry: No, indeed not.
Mr Mark Drakeford: The Welsh Government is represented by senior officials. I have made enquiries as to why we were not represented that day, alongside almost a dozen other bodies, and the information that I received was that our officials felt that the agenda that day was an agenda in which they were already engaged in other forums and that on that day couldn’t command a priority in their dairies.
But, as you say, they were at the first and third meetings and it’s our intention to continue to be involved.
Lead Inquiry: If all these bilateral or multilateral meetings or fora are to work, then of course it requires the participation of all the parties and effort to be made to attend; I’m sure you’d agree with that notion?
Mr Mark Drakeford: I do.
Lead Inquiry: The final topic, Mr Drakeford, concerns inequalities.
There is evidence that the Welsh Government has devoted a great deal of time and energy to ensuring an improvement in prospects economically, societally, on the part of its citizens and its communities. It does, nevertheless, appear that, in the field of pandemic preparedness, civil emergency planning, very little attention was given to the issue of how a pandemic would affect sectors of the community disproportionately, and how steps could be taken to ensure that the impact on those who are vulnerable and marginalised could be mitigated. Would you agree?
I should say that it is a flaw that is apparent from the analogous papers, guidance, doctrine, strategies in Scotland and in London.
Mr Mark Drakeford: I should say at the outset that addressing inequalities is absolutely in the bloodstream of successive Welsh Governments. I spent a great deal of my time in the very first Assembly term working with Professor Peter Townsend who was the – probably the world’s leading expert on health inequalities at the time to get his advice to address those issues in Wales.
I think there is evidence you will have seen from Dr Sandifer, who has given evidence, and the advice of Public Health Wales to us was, that while you had to be aware of the unequal impact of a pandemic on the population, it was very difficult to anticipate in advance of the particular nature of that pandemic where those inequalities would most fall.
So while there is evidence in the documentation of awareness of inequality and the way in which a pandemic would exaggerate existing inequalities and therefore had to be planned for from the outset, the more granular planning, which groups would be affected, how would you respond to them, you’d have to do that when the nature of the pandemic you were dealing with became more apparent. You – it just wouldn’t be possible to plan without that greater knowledge.
I think that was the advice that Public Health Wales would have given to us and I think has given to the Inquiry.
Mr Keith: Thank you, Mr Drakeford.
My Lady, those are all my questions. I believe you have granted permission to Covid-19 Bereaved Families for Justice Cymru to ask five minutes’ worth of additional questions.
Lady Hallett: Ms Heaven.
Questions From Ms Heaven
Ms Heaven: Thank you, my Lady.
First Minister, my name is Kirsten Heaven and, as I think you know, I represent the Bereaved Families for Justice Cymru.
I just want to ask you really about one very small topic around some discussions in 2013, but before we get there, can I please clarify some things from your statements about some of the jobs and political roles you’ve held.
So what you tell us in your statement is from 2000 you became a special adviser for health and social policy, I think that was to Rhodri Morgan, and I think at that time you had some experience of the SARS outbreak; is that correct?
Mr Mark Drakeford: That is correct.
Ms Heaven: We know obviously that you were elected in 2011. Can I just ask, where were you, politically, in 2009 when swine flu broke out?
Mr Mark Drakeford: I was still a special adviser to the Welsh Government.
Ms Heaven: Okay. Were you a special adviser in a health role still at that time or were you in a different role?
Mr Mark Drakeford: I was the head of the First Minister’s political office at that time.
Ms Heaven: But would it be fair to say you knew about the fact of swine flu?
Mr Mark Drakeford: Oh, I did, and I attended, in that advisory capacity, a number of meetings between Scottish, UK, Welsh and Northern Irish ministers.
Ms Heaven: 2011 to 2013, we know that you were the chair of the Welsh Assembly Health and Social Care Committee. We also know, obviously, that there was a MERS outbreak in April 2012. Did that come up when you were chairing the committee at all, do you recollect?
Mr Mark Drakeford: It would only have come up in this way: that I think, from recollection, once a term, so three times a year, the minister responsible would appear in front of the committee for what is called general scrutiny, in which any topic of the day could be raised and the minister asked questions. That would have been the opportunity for the committee to hear on that matter.
Ms Heaven: But do you recollect whether or not that happened now?
Mr Mark Drakeford: I –
Ms Heaven: You can’t?
Mr Mark Drakeford: Without looking back, I can’t recollect here.
Ms Heaven: But did you know that there had been such a thing called MERS, either then or later, when you became Minister for Health?
Mr Mark Drakeford: I would have been aware of it, yes.
Ms Heaven: You also say in your statement that you had experience of Ebola, and you’ve mentioned that briefly today, and I think that was when you were Health Minister –
Mr Mark Drakeford: Yes.
Ms Heaven: – is that fair?
And, just to be clear, you became –
Lady Hallett: Ms Heaven, sorry, I’ve been asked to ask you to slow down. I appreciate –
Ms Heaven: Sorry, I know I –
Lady Hallett: Don’t worry, I know you’re trying to keep to the timing.
Ms Heaven: I’m trying to get through.
Lady Hallett: Don’t worry, I’ll let you off if you run over if you slow down.
Ms Heaven: I will. Sorry, I’m just trying to stick to the time.
Lady Hallett: Yes.
Ms Heaven: To be clear, March 2013 was, I think, when you became elected Minister for Health; is that right?
Mr Mark Drakeford: Correct.
Ms Heaven: Okay.
So yesterday Frank Atherton was taken to some minutes from the Health Emergency Preparedness Unit, so that’s HEPU for short, and these related to a pandemic planning yearly conference in October 2013. They were chaired by David Goulding, who was head of HEPU. Now, there was no suggestion, just to be clear, that you were at this conference. We know that HEPU sits within the Health and Social Services Group and it reports to the Welsh Government.
So by the stage of October 2013 I think you had been in post for seven months. Is it safe to assume that by this stage you knew about the fact that HEPU existed and the general nature of its work?
Mr Mark Drakeford: I would have known Mr Goulding prior to becoming the Health Minister, so I would have been aware of his work and the unit, yes.
Ms Heaven: Now, what’s interesting about this 2013 conference is we can see that a talk was given by somebody called a Dr John Watkins, and I won’t bring it up just to save time, but I’ll summarise the gist of what I want to ask you about.
Now, we understand he’s a consultant or he was then a consultant epidemiologist in Public Health Wales, and he is telling this conference about how current threats include a novel virus, and he says that that pandemic influenza planning assumptions in Wales must consider that Wales could see the emergence of such a novel virus, and he talks about little background immunity, that a vaccine may not work or it may not be available. There is then a reference to virulence and transmissibility in the context of the 1918 Spanish flu, and there is also a reference to swine flu.
So in other words, he is talking about virulence and transmissibility with the potential for fast transmission and a very high death rate.
Now, as I’ve said, you were not at this meeting, we know that, but given that there is no reference in your witness statement to HEPU or this specific meeting or the gist of this information, is it safe for us to assume that you were not aware that these matters were being discussed either in this conference or in general terms, and that’s in relation to a novel virus or a Disease X, as it’s been referred to in this Inquiry; would that be a fair assumption?
Mr Mark Drakeford: I think it would be fair. I was aware of the conference, I’ve seen the report of Dr Watkins’ contribution since, but I don’t think I would be likely to have been alerted to it at the time.
Ms Heaven: So in other words you were not briefed?
Mr Mark Drakeford: Not on the contribution of a single speaker at a single conference, and I wouldn’t expect to be.
Ms Heaven: No. But just thinking generally about your state of knowledge on this, obviously you’ll appreciate why I’m asking, it’s a very important topic: novel virus, Disease X, it’s being talked about as a possible risk in 2013 in Wales. We obviously know that you went on to become First Minister for Wales, you went on to chair the Wales Resilience Forum. Did you, as either a Health Minister or even in your capacity as First Minister for Wales, specifically ask your officials – be it David Goulding or somebody in Public Health Wales – about the risk of a novel virus or a Disease X breaking out in Wales and whether Wales was prepared? So did you ask that question of anybody?
Mr Mark Drakeford: No.
Ms Heaven: Given your long experience in health and given what you had seen of the dangerous viruses that I’ve set out, would you not accept today that that was an obvious and basic question that you could and should have asked?
Mr Mark Drakeford: I don’t think I would accept it on those terms, because I would have asked myself what sort of answer I was likely to have received, other than to recognise that there are a plethora of unknowns out there that you need to be aware of, and that you need to have sources of information about, and I doubt that the answer would have gotten me much further than that.
Ms Heaven: But the point is you didn’t ask the question, did you?
Mr Mark Drakeford: I’ve –
Ms Heaven: Forgetting what the answer might have been, you didn’t ask the question?
Mr Mark Drakeford: I didn’t ask the question. You said to me that was not a reasonable thing –
Ms Heaven: Okay.
Mr Mark Drakeford: – to have done, and I was explaining – trying to explain why I didn’t ask the question.
Ms Heaven: Those are all my questions. Thank you very much, First Minister.
The Witness: Thank you.
Lady Hallett: Thank you very much, Ms Heaven.
Mr Keith.
Mr Keith: My Lady, that concludes the evidence for today.
Lady Hallett: Thank you very much indeed, Mr Drakeford.
The Witness: Thank you.
Lady Hallett: The next time we meet I think will be in Wales.
The Witness: Wales. Excellent. Thank you.
Lady Hallett: Thank you for your time.
(The witness withdrew)
Lady Hallett: 10 o’clock tomorrow?
Mr Keith: Yes, please.
(4.40 pm)
(The hearing adjourned until 10 am on Wednesday, 5 July 2023)