27 June 2024
(10.30 am)
Lady Hallett: Good morning. This is the first preliminary hearing for the module apparently known as “Test, Trace and Isolate”, but I understand I will be hearing submissions on what it is called in a moment and, given we have a number of people who wish to speak, I think it’s better we get on.
So I’ll first ask Ms Sophie Cartwright King’s Counsel, leading counsel for this module, to outline the submissions that she wishes to make.
Statement by Senior Counsel to the Inquiry
Ms Cartwright: Thank you, ma’am.
Good morning, my Lady. I do apologise. As you are already identified, I am Sophie Cartwright King’s Counsel, the senior counsel for Module 7, the focus of which concerns, in summary, the approach to testing, tracing and isolation during the pandemic in England, Wales, Scotland and Northern Ireland, and to make recommendations.
I appear, along with the other members of the counsel team for Module 7, my learned friends Ms Nice, Ms Malhotra, Ms Spector. Mrs Islam is also providing invaluable assistance in the preparation of Rule 9 requests. Lead solicitor for Module 7 is Ms Leslie, who is supported by a wider team of solicitors, paralegals and members of the secretariat.
In accordance with the agenda for this preliminary hearing, my Lady, I will address you so far as this module is concerned on the following areas: the designation of core participants; the provisional outline of scope for Module 7; evidence gathering; disclosure to core participants; Every Story Matters, our nationwide listening exercise; and future hearing dates.
There will then be an opportunity for those who have been designated as core participants for this module to make submissions if they wish to do so.
In addition to the Inquiry’s counsel and solicitor team, there are eleven core participants present in the hearing room today, with a further seven in remote attendance. Five core participants are unable to attend today.
Present in the hearing room and represented, in no particular order, are the following core participants: Covid-19 Bereaved Families for Justice UK, represented by Ms Munroe King’s Counsel; Northern Ireland Covid-19 Bereaved Families for Justice, represented by Mr Bindman; Covid-19 Bereaved Families for Justice Cymru, represented by Ms Weereratne King’s Counsel; the Federation of Ethnic Minority Healthcare Organisations, represented by Mr Thomas King’s Counsel; the Trades Union Congress, represented by Ms Peacock; the Welsh Government, represented by Mr Rogers King’s Counsel; the Department for Education, represented by Ms Ward King’s Counsel; the Chancellor of the Duchy of Lancaster, represented by Ms Studd King’s Counsel; the Department for Transport, represented by Mr Mertens; His Majesty’s Treasury, represented by Mr Block King’s Counsel; the Local Government Association and the Welsh Local Government Association, represented by Ms Stober.
Present over the link are Scottish Covid Bereaved, represented by Mr McCaffery; Scottish Health Boards, represented by Mr Pugh; NHS National Services Scotland and Public Health Scotland, represented by Mr McConnell; Baroness Arlene Foster of Aghadrumsee DBE and Paul Givan MLA represented by Ms Ellison; Public Health Wales represented by Ms Johnson; and NHS England and the Scottish Ministers are also present over the link.
Turning, my Lady, then to the practical arrangements for today’s hearing, the proceedings are being recorded and live streamed to other locations. This allows the hearing to be followed by a greater number of people than would be able to be accommodated within this hearing room.
My Lady, it also goes a considerable way to satisfying the obligations set out in section 18 of the Inquiries Act to take such steps as you consider reasonable to ensure that members of the public are able to attend or see and hear a simultaneous transmission of the proceedings.
Also, as is routine in public inquiries, the broadcasting of this hearing will be conducted with a three-minute delay. This provides the opportunity for the feed to be paused if anything unexpected is aired, which should not occur today.
We do not expect, as I’ve said, this to occur, but I mention it so that those who are following proceedings from further afield can understand the reasons for any such short delay.
Can I turn next, please, my Lady, to the designation of core participants.
My Lady, pursuant to Rule 5 of the Inquiry Rules 2006, I’ve already identified a number of the core participants, the 23 I’ve already indicated who are designated as core participants. My Lady, I don’t intend to repeat the list of those I’ve already identified, save to identify the initial – a further five who are not present in the hearing room today or attending remotely. My Lady, those further five core participants in Module 7 include: the Department of Health and Social Care; Northern Ireland Department of Health; the Public Health Agency Northern Ireland; the Secretary of State for the Home Department; and UK Health Security Agency.
A full list of core participants in Module 7 and their recognised legal representatives will be published on the Inquiry website.
Finally, my Lady, for those who are either not granted core participant status or for those who did not apply to be designated a core participant, I wish to reiterate that not being a core participant in Module 7 in no way precludes any person, entity or group from applying for core participant status in a later module, bringing any matter to the attention of the Inquiry, providing evidence and information, where appropriate and relevant, giving evidence at a hearing, and, in the case of an individual affected by the pandemic, taking part in the Inquiry’s nationwide listening exercise, Every Story Matters.
My Lady, I will turn to address the scope of Module 7 next and then move to the evidence gathering and investigation stage that has already begun for Module 7 but, before doing that, I will give a little background.
My Lady, the emergence of the Covid-19 pandemic presented the United Kingdom Government and the devolved administrations in Scotland, Wales and Northern Ireland with an unprecedented challenge in respect of testing strategy and the structure and response.
The response to the Covid-19 pandemic required the expertise, knowledge and research of medical clinicians and the scientific community, including from specialists in infectious disease, the microbiology community, epidemiologists, modellers, statisticians, behaviourists and public health to inform decision-making.
Developing diagnostic tests is an urgent priority for the international community once a novel infectious disease emerges. The same was true for Covid-19. In January 2020, just after the publication of the first genetic sequences of severe acute respiratory syndrome coronavirus 2, researchers used the data to build molecular tests for the virus.
The coronavirus Covid-19 testing programme was developed during the pandemic. You have already heard evidence, my Lady, pertaining to preparedness in Module 1. Module 7 will focus on the development of the testing programme and the timing of that development in response to the Covid-19 pandemic.
At the start of the pandemic, polymerase chain reaction tests, PCR, a type of molecular testing, was the primary method to test for SARS-CoV-2. Testing was conducted using existing laboratory infrastructure at dedicated sites, and from March 2020 it prioritised certain groups such as patients and frontline healthcare workers.
On 12 March 2020, the government announced a move out of the contain phase and into delay in response to the ongoing coronavirus outbreak, with anyone showing certain symptoms told to self-isolate for seven days, regardless of whether they had travelled to an affected area, to slow the spread of infection.
On 23 March 2020, the UK government introduced the first national lockdown. At this date, testing in the community is said to have been 23 samples per day. By late April 2020, testing capacity exceeded 100,000 tests a day. By December 2021, it is said that over 13 million samples were processed by the UK laboratory network.
The PCR capacity is said to have expanded in May 2020. It is also understood that lateral flow device tests, LFD, namely antigen tests, were developed, tested and trialled during 2020 and introduced for use in the national testing programme in late 2020. These tests gave individuals the means to self-assess whether they were infectious without needing to use a laboratory process.
It is said that lateral flow device tests became increasingly central in testing strategies as a way to rapidly test symptomatic and asymptomatic people on a weekly basis without needing to further expand laboratory capacity. It is understood that, in under five months, the number of LFD tests reported using the existing UK National Testing Programme digital infrastructure rose from 23, in the week commencing 22 October 2020, to more than 7.6 million, in the week commencing 11 March 2021.
In order to break chains of Covid-19 transmission during the pandemic, testing was used to identify new cases as part of a strategy to test, trace and isolate infected individuals. Test and trace programmes are a core public health response in an epidemic/pandemic, and Module 7 will example the test, trace and isolate system in a United Kingdom context.
The basic principles of test and trace are identifying infected individuals, or groups of individuals through testing, and tracing their contacts as early as possible. Potentially infected contacts are then encouraged or obliged to reduce interactions with other people (to self-isolate), thereby reducing the spread of disease. This is of significance on an island such as the United Kingdom, and Northern Ireland also, within the island of Ireland.
The devolved nations of the United Kingdom have authority and responsibility for public health in their own jurisdiction and Module 7 provides an opportunity to examine the co-ordination between the devolved nations and Westminster in their test, trace and isolate response.
Module 7 will need to consider the full range of circumstances when designing a shared testing system. Data and health systems differ across the four nations. Testing policy and delivery is complex, with multiple interacting systems and needs and the need to work collectively with colleagues from across the United Kingdom, across the relevant sectors and organisations involved, and while enabling appropriate governance within each nation for operational delivery and devolved responsibilities.
In Module 7 we will investigate Test and Protect (Scotland), Test and Trace (England), Test, Trace, Protect (Wales) and Test, Trace and Protect (Northern Ireland) and any variations in the measures adopted by the governments to contain the Covid-19 virus, the reasons for any variations, and the timing and implementation of decisions.
Module 7 will further consider the consistency of decision-making across the four nations.
This, my Lady, is essential to inform the required recommendations that will flow from Module 7 and to help public health efforts to stem the spread of viruses across the United Kingdom in any future epidemic or pandemic.
My Lady, turning then to the outline of scope for Module 7. The provisional outline of scope for Module 7, which is available in Welsh on the Inquiry’s website, states:
“This Module will look at, and make recommendations on, the approach to testing, tracing and isolation adopted during the pandemic in England, Wales, Scotland and Northern Ireland from January 2020 until February 2022.
“The module will consider the policies and strategies developed and deployed to support the test, trace and isolate system by the [United Kingdom] Government and the Devolved Administrations. It will consider the decisions made by key bodies, other options or technologies that were available and factors that may have influenced public compliance.”
Module 7 will examine:
The test, trace and isolate policies and strategies developed and deployed, taking into account modelling, capacity of the systems throughout the pandemic and the rationale, appropriateness and data available for the decisions of the United Kingdom and devolved administrations and wider border policy considerations.
[Module 7 will examine] the availability, use and effectiveness of different test, trace and isolates technologies, policies and strategies including lateral flow and PCR tests, testing for variants, digital contact tracing and other testing technologies.
[Module 7 will examine] the structure of the test, trace and isolate system and the key bodies involved in decision-making in the United Kingdom and devolved administrations. It will include the efficacy and impact of the models adopted, the use of the private sector and other institutions and the cost.
Fourthly, enforcement of testing, tracing and isolation procedures and factors influencing compliance, such as the adequacy of and trust in messaging, financial and practical support to those required to isolate and the availability and use of data in decision-making.
Module 7 will also examine the preservation of infrastructure, capacity and research to improve and develop test, trace and isolate schemes for future pandemics.
My Lady, the scope remains provisional and will continue to be reflected upon as evidence is received through the Module 7 investigation.
The Module 7 team is also mindful of other modules’ investigations that may touch upon issues relevant to test, trace and isolate. This includes, although is not limited to, module 5, which is looking at the procurement of lateral flow tests and PCR tests. A future module reviewing the government’s business and financial responses is also anticipated. The Inquiry teams will continue to work together to avoid duplication.
However, whilst the scope remains provisional, to assist core participants’ understanding, we have identified some of the questions that the Inquiry in Module 7 is likely to be considering. This will be expanded upon in the circulation of the list of issues ahead of the hearing. These issues include:
What policies and strategies for test, trace and isolate were developed and deployed in England, Wales, Scotland and Northern Ireland and how did they vary across the four nations?
Were the policies and strategies deployed effective at meeting their stated objectives?
Did the development of the overarching strategies and policies take account of the public sector equality duty? And how effective were any steps taken to mitigate unequal impacts on the general population across the United Kingdom and, in particular, vulnerable groups?
How effectively were the adopted policies and strategies communicated to the general public?
How did available data and scientific or expert advice, including modelling, inform the development of the policies and strategies?
How effectively was technology used in the roll-out of the test, trace and isolate system?
How effective were the tools in place for enforcing and monitoring isolation?
Were appropriate steps taken to support people to comply with test, trace and isolate?
What recommendations can be made for future pandemics?
The Inquiry and Module 7 must maintain a tight focus on the key issues. The Inquiry team’s investigation in relation to Module 7 is already under way, with progress having been made. We have started the process of gathering evidence and identifying areas for expert evidence, topics to which I will return in a few moments.
My Lady, in advance of this hearing you have received submissions from core participants on the scope of Module 7. A number of the core participants have made suggestions for matters that should be included in the provisional outline of scope and also list of issues. It is not practicable for me to address all of those today, although I will address a number, and core participants may in turn raise issues with you in their oral submissions.
All of the submissions that have been received require and are receiving careful consideration. It may be that some suggestions accord with our own understanding of the scope or planned refinement of the scope.
Turning first to submissions in respect of terminology, whilst the provisional scope and the note provided in advance of this hearing refer to testing, tracing and isolation, Module 7, as a four-nation module, will include investigation of and consideration of Test and Protect (Scotland), Test and Trace (England), Test, Trace, Protect (Wales) and Test, Trace and Protect (Northern Ireland). Where “test, trace and isolate” is used in correspondence with core participants, it is intended to acknowledge the different models adopted across all four nations, which will be investigated.
Submissions on Behalf of Scottish Covid Bereaved by Mr McCaffery
Mr McCaffery: Thank you to Counsel to the Inquiry for her helpful oral submissions this morning.
I appear this morning, my Lady, to make oral submissions on behalf of Scottish Covid Bereaved as one member of the counsel team, including Claire Mitchell King’s Counsel and David Welsh and Kevin Henry, advocates, as instructed by the Inquiry’s team at Aamer Anwar & Company Solicitors.
Scottish Covid Bereaved are once again grateful to the Inquiry for being included as a designated core participant in Module 7. Further, we are grateful to Counsel to the Inquiry for providing her detailed note setting out the matters which are to be addressed at today’s first preliminary hearing.
Scottish Covid Bereaved have submitted written submissions and we trust that those, together with today’s oral submissions, will be of assistance to the Inquiry.
Following the Counsel to the Inquiry’s outline order of submissions, those on behalf of Scottish Covid Bereaved, my Lady, are in respect of outline of scope. Scottish Covid Bereaved welcome what appears to be a wide approach to the development and deployment of the test, trace and isolate policies and strategies which were set up at substantial cost in the UK and the devolved nations, and in particular Test and Protect (Scotland), as the Scottish programme was titled.
Such policies and strategies had, of course, a significant impact on all of our lives during the pandemic, particularly during periods of lockdown and on vulnerable groups and those who continued to have a requirement to travel throughout those periods, whether employed in key worker occupations such as health and social care, education and childcare, in food, necessary groups and transport, on those who faced the significant challenges which came with having loved ones who were hospitalised, in residential care or living alone in unsupported accommodation, and these who relied heavily on regular contact with and assistance from close family members, a category which many of the members of Scottish Covid Bereaved belong to.
It is in, in our submission, my Lady, of vital importance to the members of Scottish Covid Bereaved to obtain answers to why the systems which were supposed to be facilitating their ability to maintain contact with their loved ones, appeared to fail in that task despite the eye-watering sums of money which were allocated to the different programmes.
Why, despite the huge financial cost, there did not appear to be any coherent strategy in developing trusted systems and an apparent lack of, or insufficient, co-operation and co-ordination between the nations to combine in a concerted effort to develop an effective system when other countries seemed able to develop and institute what appeared to be much more reliable systems, apparently at much reduced cost.
We note that the Ada Lovelace Institute hosted an event in May 2020 bringing together experts from the devolved nations of the United Kingdom to ask how joined-up approaches to Covid-19 technologies across Scotland, Northern Ireland, England, and Wales could help to contain the virus and foster public trust. Sadly, they later reported in September 2020 that that joined-up approach had not transpired.
We note the Inquiry’s intention to examine each of the systems and how they varied from each other and the impact of enforcement, particularly on vulnerable groups, and what, if any, steps were taken to avoid inequalities between different sectors of society and how effective or not those were.
We trust that this will also encompass cross-border issues where there seemed to be a lack of compatibility between systems with different approaches and, at times, even different restrictions in place, all of which will hopefully provide invaluable guidance for future pandemics.
Whilst we welcome the Inquiry’s intended approach, we trust that each nation will be afforded a sufficient allocation of time for evidence to be heard and considered which is directly relevant to its own particular situation. It does seem an ambitious aim to cover the individual systems of all four nations in a single module of a provisional three weeks’ duration, and we respectfully suggest that the Inquiry give consideration to adopting a similar approach to that of Module 2 in allocating a block of days for each nation’s particular model and issues.
In respect of evidence gathering, my Lady, we are pleased to note that the in-gathering of evidence has commenced and that Rule 9 requests are already being issued for this module. We commend the Solicitor to the Inquiry’s team in displaying its usual efficiency in this regard. We look forward to receipt of further updates, as and when they become available from STI.
In terms of disclosure to core participants, my Lady, we trust that disclosure will commence as soon as as is possible following receipt and review of any materials and repeat the obvious, as ever, that the sooner this happens, the sooner we shall be able to prepare for the evidential hearings and offer any further assistance to the Inquiry that we are able to.
We are keen, my Lady, to learn who the Inquiry intends to instruct to provide expert reports and whether the same experts will be asked to comment on each nation’s individual model or if specific expert evidence will be sought from those with a particular knowledge of, say, the Scottish system which was adopted and how this compared with those of the other devolved nations and what can be learned going forward.
With regard to Every Story Matters, my Lady, we are confident that members will continue to offer insight into the subject matter of Module 7, as they have in the past in other modules, and to share their experiences of Test and Protect (Scotland) and how it impacted them during the pandemic. In particular, we welcome the targeted research being undertaken by the Inquiry into the experiences of families of people who were clinically vulnerable during the pandemic, ethnic minority healthcare workers, people living with Long Covid, and people with disabilities among others, and also the additional research based on the key lines of enquiry and the practicalities of accessing and using PCR and LFT tests.
As for future hearing dates, my Lady, we hope that confirmed dates will be available in the near future to allow for the necessary planning for attendance at the hearings and note the provisional estimate of three
weeks in spring 2025. We reiterate our concern that the
intended timescale is ambitious and hope that
consideration might be given to extending this highly
significant module into nation-specific components.
Finally, my Lady, we look forward to continuing to
co-operate with and assisting the Inquiry with Module 7
in any way we can, as with previous modules.
Those are the submissions on behalf of Scottish
Covid Bereaved, my Lady, unless I can be of any further assistance.
Lady Hallett: Very grateful, Mr McCaffery. Thank you, very helpful as ever. Right, I think we’ll break now rather than go on to Bereaved Cymru and I shall return at 11.55.
(11.40 am)
(A short break)
(11.55 am)
Lady Hallett: Right, next it’s Ms Weereratne, who is hiding at the back as ever.
Ms Weereratne: My Lady, I hope I can be heard even if not fully seen.
Lady Hallett: You can.
Submissions on Behalf of Covid Bereaved Families for Justice Cymru by Ms Weereratne KC
Ms Weereratne: Good morning, my Lady, I appear on behalf of Covid Bereaved Families for Justice Cymru and I’m accompanied today by Mr Court and Ms Harriman, instructing solicitors from Harding Evans from Newport. I apologise for their delayed arrival this morning, which was due to significant delays of trains from Wales.
We thank Counsel to the Inquiry for her note and detailed submissions this morning responding to written submissions. We too have filed written submissions, which we rely on today, and I rise primarily to make these submissions by way of emphasis, and to comment as appropriate and needed on the helpful submissions made by other core participants. And I propose to broadly address six areas briefly, but if I may first, by way of background, set out some brief details of the group for the benefit of those who are new to this module and to this Inquiry.
This was a group set up to campaign for and give a voice to the bereaved by Covid-19 in Wales. The group is committed to ensuring that there is proper scrutiny of all governmental decision-making relevant to Wales, and this includes decisions made in Westminster and by the devolved administration in Wales.
Since it was established in July 2021, it’s become a prominent organisation in Wales in the discourse surrounding the Covid-19 pandemic to ensure proper scrutiny within this Inquiry of decision-making impacting Wales. The group comprises 315 individuals or so, who represent the full spectrum of families in Wales affected by the pandemic.
Members of the group have professional experience working in sectors involved in or impacted by the UK and devolved government’s risk management and civil emergency planning. They have valuable first-hand experience of how deficiencies in pandemic preparation contributed to the losses the group suffered a whole.
It has met many times with the First Minister of Wales and engaged with the Welsh Government and the UK Government. The group campaigns tirelessly for justice for the families in this group. It’s played a leading role in calling for a Welsh Inquiry, so far with a disappointing lack of success, but this is a non-political group.
The group has also forged links with other interest groups to ensure awareness of and participation in this Inquiry. For example, Medics 4 Mask Up Wales, Asthma and Lung UK (Cymru), Long Covid Wales, Churches Together in Wales, Muslim Doctors Cymru and many others.
On a core participant status, we’re of course very grateful to have been granted CP status. The inclusion of separate bereaved families’ groups from the four nations in this Inquiry, and in each module thus far, is testament to the Inquiry’s oft stated commitment to exploring the experiences of each of these nations during the pandemic, and we welcome the further reassurance provided by Counsel to the Inquiry this warning on that point.
Our concern, as ever, is that this is done in a meaningful manner, so that all lessons may be learnt, including as to the specific localised needs and deficits in each nation and how they were identified and responded to, and crucially so as to benefit all corners of the UK in any future pandemic.
This is particularly important for the people of Wales because this is their only opportunity to have their experiences investigated, there being no dedicated Welsh Inquiry, and we adopt a Scottish Covid Bereaved submission made a moment ago in relation to the time given to each of the home nations in evidence heard during the hearings in this module.
Next, turning to scope, Test, Trace and Protect (TTP), using the Welsh terminology, is a key module in this Inquiry overall and a cornerstone of any response to a pandemic, and that was acknowledged by Counsel to the Inquiry this morning. It was a core response to the Covid-19 pandemic.
In June 2020 Sir David King, a former Government Chief Scientific Adviser and from Independent SAGE, said something I do not believe is controversial within this Inquiry, that the UK had come to Test and Trace too late. He said everyone knows that even before lockdown you need to know where the disease is to be tracing, testing and isolating people. It is, therefore, of fundamental importance for this module to interrogate the fact that there were significant differences in key decisions on test, trace and protect, and many substantial variations of approach across the home nations. It’s a very important focus that must not drift towards England.
We note that the Welsh Government submissions refer to a bespoke TTP programme in Wales. The lived experience in Wales, however, was of a chaotic system, with ineffective, confusing and often late and contradictory messaging. So, for example, routine testing of patients being sent from hospitals to care homes was not implemented in Wales until two weeks after England, with devastating effects. In that time, it’s estimated that over 1,000 patients potentially infected with Covid were discharged to vulnerable care home communities. The lack of cohesion between the four nations and the impact on infection rates must be robustly investigated in our submission.
It is our clients’ position that the Welsh government’s handling of TTP had a devastating effect on Wales and the loss of life there. Further, on that point and jumping to the qualitative research project proposals in CTI’s note, I would like to raise the additional point that the potential audience group for that research, as set out in paragraph 42 of her note, must explicitly include groups from Wales and other devolved nations in each of the identified categories, so that each of people with disabilities, clinically vulnerable or with Long Covid, and so on, must explicitly include sampling from Wales. Without such an approach, the inclusion of Wales and other devolved nations in this module will be at risk of being perfunctory.
At paragraph 9 of our written submissions we itemise areas for investigation and research and KLOEs that we propose are essential from a Welsh perspective. I would like to flag at this point that this is not an exhaustive list and we would like to reserve our position with regard to adding to or amending it as the process of disclosure proceeds.
We are grateful that other core participants have raised issues such as the financial and other support provided to ensure full compliance by those required to self-isolate, which we also consider to be important, and, again, we welcome the reassurance given by Counsel to the Inquiry this morning in this regard.
Our next point is on preparedness for the pandemic on TTP and, again, we note and welcome Counsel to the Inquiry’s submission this morning that resources available across devolved administrations prior to the pandemic will be investigated.
This acknowledges that decision-making didn’t start in a vacuum or from scratch in January 2020. We agree with other core participants’ submissions which raise the need to enquire into the position or understanding on the ground prior to or leading up to January 2020 in order to understand the state of preparedness, and we emphasise that now to the extent that it may go further than the resources referred to by Counsel to the Inquiry in her submission.
Lady Hallett: I’m sorry, can I just interrupt there? I’m so sorry, I just wanted to make sure I understand.
I don’t really follow, with respect, to either you or the submissions made in writing what the difference is between the position as at January 2020 and what you are suggesting, because the Inquiry team are planning to investigate the position as at January 2020. So what I’m not following is what you wish to add.
Ms Weereratne: I think it’s just a matter of caution and to ensure that that means it’s not a hard-edged starting point, so that knowledge proceeds from that point on, it’s to acknowledge that there was knowledge on the ground before that, and that that – if that means that that’s taken into account, all well and good, but it’s a matter of, certainly from our perspective, a cautious approach to ensure that what was known and what led to the knowledge that was available as at January 2020 is not somehow left behind.
Lady Hallett: Thank you.
Ms Weereratne: So, just to complete that, our submission is that it would provide a more meaningful answer, for example, to questions proposed at paragraph 20(e) of Counsel to the Inquiry’s note relating to the modelling responses and to inform the development of policies and strategies, so that there is a continuum of information that feeds into those processes.
I hope that’s clear, my Lady.
Lady Hallett: Thank you.
Ms Weereratne: On international comparisons, and it’s a point I believe that Counsel to the Inquiry did not address this morning, it’s now known that the UK fared particularly poorly on TTP by comparison with similar nations internationally. We’ve highlighted in our submissions South Korea but there are others, such as New York, where rates of, for example, self-isolation were in the region of 98 per cent, as the opposed to fewer than 30 per cent in Wales in December 2020. Germany and Australia have also been highlighted in this regard.
So we’ve suggested that it is appropriate in this module to draw from and learn the lessons of those other nations. The pandemic was, after all, global. We note and support submissions made by other CPs on this point as well and we would urge the Inquiry to include such knowledge and experience within this investigation, because it’s likely to provide useful and instructive learning for future pandemics.
So finally, on timing, we note the full hearing is proposed to take place in three weeks over the late spring of 2025 and starting some five to six weeks after the conclusion of Module 5. We did previously flag our concerns at an earlier module at a preliminary hearing at timing, not just that enough time should be allocated to each module, which is a point we do repeat also today, but also that the rapid succession of hearings planned from September, to now include Module 7, all to be heard next year, gives rise to some concerns and problems really for particularly non-state CPs in keeping up with preparation.
So we repeat our concerns that the timetable currently potentially impairs effective core participant participation, particularly, as I say, of non-state CPs, who need more time to get to grips with the volumes of disclosure and to respond to the requests made by the Inquiry legal team. We face the prospect that we will be dealing with final submissions in one module as we’re heading to the start of the next.
And, in making that submission, we’re not advocating wholesale delays, and appreciate the constraints that the Inquiry operates under, but we do say it is necessary to pay full heed to the impact on non-state CPs in particular and their ability to participate and assist.
We highlight that reliance – and understand the reliance placed by the Inquiry on material providers to provide information and evidence in good time and we note the timely use of Rule 21s in previous modules to assist with that process. We would obviously request that the Inquiry consider their use in this module as necessary to keep up and to allow the full participation of core participants in this module as well and that they should be considered, therefore, in this module also.
So with those submissions, my Lady, I have nothing further to add unless there’s anything further I can help you with.
Lady Hallett: No, thank you.
Just those you represent obviously understand, I will be reading everything you submitted in writing very carefully as well. So thank you very much.
Ms Munroe, are you next?
Submissions on Behalf of Covid-19 Bereaved Families for Justice UK by Ms Munroe KC
Ms Munroe: Good afternoon, my Lady.
I appear today as ever on behalf of Covid Bereaved Families for Justice UK. I am instructed by Mr Elkan Abrahamson, of BJC, who sits next to me to my right. I’m also assisted today by counsel Mr Christian Weaver, who sits to my left.
My Lady, I am grateful that the submissions, which are joint submissions, written submissions, on behalf of both Covid Bereaved Families for Justice UK and Northern Ireland Covid Bereaved Families for Justice have been submitted, and I’m grateful that they will, of course, be read carefully and in detail.
There will be matters in these oral submissions that I won’t speak to, not because we resile from them or we think they are less important, but, mindful of the time, my Lady, I intent to concentrate on perhaps three or four main topics, and there will be other matters that Mr Bindman, who represents Northern Ireland Covid Bereaved Families for Justice, will deal with in more depth and more detail.
My Lady, by way of some general observations in relation to this module on behalf of our families, as you know very well now ours is an extremely large and diverse group, encompassing people from many sections, and indeed every section and strata, of society, professionals with direct involvement in many of the matters under investigation by the Inquiry, as well as individuals, families, citizens who were impacted as – many, many different ways by this pandemic.
For our families, this module is particularly important. A robust test, trace, isolate and support system is fundamental. It’s necessary from the earliest possible point of a major disease outbreak at scale to swiftly identify and isolate cases, to trace contacts and to implement targeted interventions to curb the spread of the virus and mitigate its impact on communities and public health.
For many of our families, however, the track and trace system that was put in place in this country failed to do so and failed to deliver on practically all fronts, which is why they believe this is such an important module.
Indeed, as far back as October 2021, the Public Accounts Committee chaired by Dame Meg Hillier, stated that the track and trace system had failed to achieve “its main objective”, which is to cut infection levels and help Britain return to normal. The report added that the failure was despite the “eye-watering” sum of £37 billion in taxpayers’ cash, or 20 per cent of the NHS’s entire annual budget over two years, having been spent. She went on further, and I quote:
[as read] “Only 14% of 691 million lateral flow tests sent out had results reported, and who knows how many took the necessary action based upon the results they got or how many were never used. The continued reliance on the over-priced consultants who ‘delivered’ this state of affairs will by itself cost the taxpayer hundreds of millions of pounds.”
Although often referred to as an “NHS Test and Trace”, with the exception of the contact tracing app itself, the system has always been almost exclusively run by private companies, with large contracts awarded to companies, as Ms Cartwright King’s Counsel set out this morning, such as Serco, Sitel and Deloitte. These companies then subcontracted out work to smaller companies and, when things began to go wrong, it was council-run tracing departments that often took up the contact tracing thereafter.
Just by way of example, my Lady, of some of the many issues that concern our families that are likely to arise out of this module:
The app development, that was in fact developed by NHSX, the NHS’s technology department, which for some reason decided to develop its own contact tracing app without the help of the two of the largest and most experienced app developers on the planet, namely Apple and Google. The resulting app was somewhat disastrous.
Low level contact tracing, SAGE had stated that something in the region of 80 per cent of contacts with coronavirus cases needed to be contacted and told to self-isolate in order for the system to be effective. For many months, thousands of contacts were never reached or told to self-isolate and the virus spread exponentially. Self-isolation compliance had been low.
The target to turn around results to face-to-face tests were never met.
Testing centres, Dr Kit Yates, a mathematical biologist at the University of Bath, again back in October 2021, told The Guardian:
“We now know 43,000 people are believed to have been given false negatives, but this doesn’t even come near to the cost of the mistake.
“Many of these people will have been forced into school or work, potentially infecting others. This could be part of the reason behind some of the recent rises we’ve seen.”
So for those and myriad other reasons, my Lady, this module is extremely important to our families.
We’ve listened very carefully to Ms Cartwright King’s Counsel’s detailed, constructive and very helpful responses to the specifics within the submissions not only of ourselves but other CPs this morning, and it is within those responses and observations that she has made that I make the following comments.
Firstly, scope. Of course we recognise the area of scope is a developing one, it’s going to be evolving, and we therefore well necessarily keep – we will all keep it under review, particularly having regard to the large volume of material that, in due course, will come our way.
But just perhaps two or three points under scope. Preparedness, and perhaps this is moving on from what has just been said, effectively what we say is in similar terms, my Lady, and I think you have the point now. Preparedness, of course, was something that was the raison d’etre of Module 1, but certainly our understanding, and many other CPs’, was that one can’t simply compartmentalise preparedness, that it is a thread that goes throughout the Inquiry, and it has to be revisited in different levels according to the matters under investigation in a particular module, and we simply wish to make sure that is kept very much at the forefront.
So I’ll say no more about that point.
Support. Under the heading of “test, trace, isolate and support”, I welcome and we welcome and we’re pleased to hear what was said this morning in relation to those submissions that we made. Clearly, support as part of that narrative is vitally important. The Inquiry will need to investigate and examine that in order to make meaningful recommendations and to learn those lessons. And support clearly encompasses financial, particularly for workers who are in vulnerable jobs, at risk of losing jobs because of isolation, for example workers on zero hours contracts would be susceptible to job loss, economic hardship and no sick pay if they didn’t work. It also includes support for physical and vulnerable individuals.
Some of our families lost loved ones who were economically vulnerable to the spread of Covid in the work place, such as factory workers, TFL workers, those who worked in transport and in care homes. Therefore, the robust test, track and isolate and support was critical for those families, particularly at the start of 2020.
But, as I say, my Lady, we do welcome what was said this morning by Ms Cartwright King’s Counsel that clearly this is something that the Inquiry has very much in mind and very much to be part and parcel of scope.
Compliance. We noted in our written submissions that in the fourth paragraph of the scope section of CTI’s note for Module 7 it’s stated that it will examine:
“Enforcement of testing, tracing and isolation procedures and factors influencing compliance, such as the adequacy and trust in messaging, financial and practical support to those required to isolate, and the availability and use of data in decision making.”
That is doubtless important but we do also urge, my Lady, that the Inquiry, in order – to thoroughly examine what was known and considered in advance about the psychological and social effects of implementing testing, tracing and isolation measures. Such an understanding, we say, is a crucial first step in order to then understand the actual factors that influence compliance.
The international component. I’ll say not a great deal about that for now. It’s there in our paragraph 10 and Mr Bindman will, in due course, speak to you and address you further on that point. Save to say this, my Lady: we know that we are working in a limited time frame for this module. It’s vast. That can be said for every single module in this Inquiry. There’s lots of competing issues that will need and require time. So we’re not suggesting that the Inquiry has the ability to have an in-depth comparative analysis and league tables between this country and abroad but simply what we say is that there is learning, potential learning to be had from how certain countries fared, and looking at that international component may well assist the Inquiry in terms, again, of findings and, importantly, recommendations and lessons to be learnt.
Then, under scope: the discrimination. It’s a point, my Lady, that we do making regularly in our submissions, and I welcome again what was said this morning in terms of the investigation that certainly this module will be undertaking into the unequal impact on various sections of society.
We also note what was said in terms of reference to the public sector equality duty. We simply say this, my Lady, that it is important that particularly in this instance – I think that disability, which perhaps has not been as prominent as some other aspects under the broad umbrella of discrimination, will be particularly important here, and scope should reflect that.
In terms of experts, again, rather than reinventing the wheel and looking for new experts afresh, first and foremost we have, starting with Module 1 and moving into Module 2, and also Module 3 to come, an array – a vast array, a growing array – of highly qualified and eminent experts who have already reported on these issues and may well be able to be revisited to look at this particular issue in Module 7 or, if not, be able to point us in the right direction. So that’s what we say in terms of experts.
We also would urge upon the Inquiry that whilst, of course, the process that we undergo whereby once reports are available in draft form CPs can comment upon that, and that’s important, it’s a very useful exercise, perhaps being involved at an earlier stage in terms of discussions about the experts who will be instructed, the ambit and remits of their instruction, would also be a very constructive measure and may well save some time.
My Lady, that’s all I say in relation to scope.
The second point, disclosure. Again, it goes without saying that we do not underestimate the enormity of the task in hand, the disclosure that will begin when we are all deep in Module 3, but that’s the nature of the situation that we’re in.
What we do say is that, firstly, in light of the comments made by Ms Cartwright this morning that CTI will be seeking, in terms of document providers, information about individuals involved, meetings, summaries of documents, that is very, very welcome, and perhaps there is not so much difference between what is envisaged by CTI and what we say in our submissions about a corporate narrative. It’s important, we say, that those who are providing the documents are not necessarily the ones who are dictating the terms. If anything, it should be the other way round. If one is trying to target disclosure, it’s very difficult to target disclosure when you don’t know what is available.
Our families are concerned that without some sort of corporate narrative from each provider, there is a danger that things may be omitted. It could allow providers to withhold relevant information and later claim not to have disclosed it because the Inquiry didn’t specifically ask for it, or innocent misunderstandings could arise.
The approach we propose has been used in good effect in previous inquiries, my Lady, and we see it as something that assists not just CPs but certainly would assist CTI and assist the Inquiry generally in terms of being able to have the best possible – one won’t receive every single document before the start of the modules, we’ve seen that, but the best possible chance of having a comprehensive array of material before we start each module.
Lady Hallett: I am afraid I’m going to have to ask you to –
Ms Munroe: I am coming to the end now, because I was going to say –
Lady Hallett: Ms Munroe, you know what I’m like.
Ms Munroe: I do.
On timetable, again that’s something that Mr Bindman will address you on, and we make the points in our paragraph 19. They are similar to points that have already been made on behalf of other CPs. Likewise Every Story Matters. We note what is said this morning but nonetheless we make those points in our paragraph at the end of our written submissions that, whilst the topics contained within the key lines of enquiry are relevant and important, we still hold the view that there may be a danger that targeted research will substitute that which the Inquiry could well do and should do itself, i.e. call written and oral evidence on those matters.
My Lady, unless I can be of any further assistance, those are our submissions.
Lady Hallett: As helpful as ever, Ms Munroe. Thank you very much.
Just so everyone knows, I think – unless it takes much longer than people have been allotted, I am going to try to finish this morning before we break for lunch.
So Mr Bindman.
Submissions on Behalf of Northern Ireland Covid Bereaved Families for Justice by Mr Bindman
Mr Bindman: Thank you, my Lady.
My Lady, I appear on behalf of the Northern Ireland Covid Bereaved Families for Justice. We are grateful for the granting of core participant status in this module and others, and indeed for the points raised in Counsel to the Inquiry’s submission before you this morning.
My Lady, you have the written submissions that were submitted jointly with the UK Government Covid Bereaved Families for Justice team and I don’t propose to go through those or repeat them here. We also endorse the submissions just made by Ms Munroe King’s Counsel, and urge the Inquiry to consider the points raised therein.
I wish only to make some brief submissions on behalf of the Northern Ireland Covid Bereaved Families for Justice aimed at drawing your attention to the fact that specific and distinct issues relating to the availability and operation of test, trace and isolate as a strategy arose in relation to Northern Ireland during the pandemic and that these issues must receive meaningful attention in this module in order to do justice to the clients that we represent.
Having very recently presided over Module 2C in Belfast, your Ladyship will now be fully aware of the political and operational issues that affected the devolved administration’s response to the pandemic.
You will also recall from the evidence in Module 2C that when it came to test, trace and isolate, or test and trace, Northern Ireland was in a rather different position to England. Contact tracing was suspended in Northern Ireland on 12 March 2020. However, at that stage, Northern Ireland only had a handful of positive cases and retained excess testing capacity.
The evidence suggested that this decision was taken on the basis of a central government decision to move from the contain to delay phase of the pandemic and an analysis that England would soon run out of capacity. However, the appropriateness and necessity of such a move for Northern Ireland appeared to receive no proper analysis in central government or in Northern Ireland itself at all.
In fact, Northern Ireland was potentially in a very good position to utilise test, trace and isolation as a strategy to suppress the virus and reduce the deaths in those early weeks, something that successfully occurred in a number of other jurisdictions. Northern Ireland benefited from a relatively small population and lagged some weeks behind the rest – in terms of the onset of Covid infection in the population, lagged some weeks behind the rest of the UK. As a result, had a sufficiently scalable test trace contract tracing infrastructure existed or been created in the early part of the pandemic, then it could have had a dramatic effect.
It’s important to highlight that background, my Lady, to urge the Inquiry to give sufficient focus to the particular situation in Northern Ireland. Module 2C showed that there was a lack of emphasis placed on test and trace in Northern Ireland, with decisions relating to it being dependent on those taken in London without proper Northern Irish input. Within the Northern Ireland administration itself, its importance as a tool in fighting the disease, as opposed to simply quantifying it, appears to have been given inadequate attention.
These failures and the potential for a properly resourced test and trace strategy to prevent excess deaths in any future pandemic are, we say, essential matters for this module to consider in the specific context of Northern Ireland. Whilst it is accepted that the Inquiry has a significant amount to cover in a short period of time, and of course no-one is denying the scale of the task at all, the issue of test and trace is a fundamental one for those that we represent.
If, as appears may be the case, test and trace could feasibly have worked in Northern Ireland in a way that could have reduced infection rates and deaths and limited the need for the painful lockdowns that followed the onset of the pandemic, lessons must be learned for future pandemics.
As we have said in the written submissions, any such analysis must also give consideration to the land border between the north and the south of Ireland and the effect this may have on attempts to use test and trace in a future pandemic.
Finally, and as Ms Munroe alluded to, and within the context that I’ve already set out, we reiterate the request for expert evidence on the use of test and trace amongst international comparators and the efficacy of it. For the reasons set out in our written submissions, this need not and could not involve a significant focus of Module 7 being diverted to looking at the international picture. Instead, given the differences between the four nations and the unique, geographical position of Northern Ireland, some understanding of how test, trace and isolate as a strategy was deployed to good effect in other countries is very important in determining how it might have been in the UK, and in particular in a jurisdiction with its unique features such as Northern Ireland.
It is respectfully submitted that no analysis of test and trace during the pandemic can take place in isolation. Evidence pointing towards or away from test, trace, isolate as an effective strategy in a UK-wide pandemic must at least be considered against examples from other jurisdictions.
My Lady, it was mentioned that I would say something in relation to timetable. I don’t have anything very specific to add, save that we reiterate the points that were made in the written submissions. Fully understand the constraints that this Inquiry is under, as ever, but there is a lot of material to get through, and whether that is possible in that timetable is, we say at this stage, somewhat doubtful.
My Lady, unless I can be any further assistance.
Lady Hallett: Thank you very much for your help, Mr Bindman, very grateful.
Right, it’s Mr Thomas.
Submissions on Behalf of the Federation of Ethnic Minority Healthcare Organisations by Mr Thomas KC
Mr Thomas: Good morning, my Lady.
Lady Hallett: Good morning.
Mr Thomas: My Lady, FEMHO would like to extend its gratitude to you for the opportunity that you have granted to allow them to present these submissions, and recognising FEMHO as a core participant in this crucial module.
As you know, and I won’t dwell on this, you know that FEMHO represents the interests of ethnic minority healthcare workers and their families who were disproportionately affected by the Covid-19 pandemic. The UK Government’s test, trace and isolate system and strategy was particularly impactful on ethnic minority healthcare workers and communities.
Systemic shortcomings. The systemic shortcomings of the test, trace and isolate strategy must be examined, we say, within the context of pre-existing inequalities which were exacerbated by the Covid-19 pandemic, and we’re really grateful to hear your counsel’s approach to that this morning. We really welcome that.
There were a number of failures, TTI failures, and if I can just touch upon a couple of examples just to flag them.
So, for instance, areas with substantial ethnic minority populations (such as Bradford, Luton, Blackburn) experienced significant failures in the TTI system. It could be said that some of these failures were largely attributable to socio-economic factors that disproportionately affected these communities. For instance, overcrowding meant that individuals were effectively – it made it more difficult for them to self-isolate, even when advised to do so after potential exposure to the virus. Many individuals in these communities held jobs that offered little job security or sick leave forced them to choose between isolation guidelines and risking financial hardship.
Moreover, my Lady, the lack of targeted support and consideration for these vulnerable populations contributed to low compliance rates within the test, trace and isolate measures. So, my Lady all of these things, we say, are important and crucial to understand. In this module, these things need to be touched upon.
Let me move on. Economic support and compliance. Financial insecurity. My Lady, lower testing and isolation adherence rates were predictable, we say, given the financial insecurity and lack of support for individuals, particularly for those from ethnic minority groups. Government failure to provide sufficient financial assistance for self-isolation left many unable to comply with the TTI measures without facing severe financial hardship.
And then there were employment concerns and these cannot being ignored. Migrants on employment-dependent visas and those with no recourse to public funds faced legitimate and serious concerns about engaging in the trace, test and isolate system and this further undermined the strategy’s efficacy.
Slow roll-out in testing, delayed screening. The roll-out of testing was slow with routine screening for healthcare workers only starting in November 2020, long after an asymptomatic transmission was recognised. This delay particularly affected support staff in healthcare settings.
Then, my Lady, unequal treatment in TTI enforcement, discriminatory practices. There have been alarming instances where ethnic minority staff were told that TTI policy did not apply to them or were called back to work before their isolation periods ended. This unequal treatment must be scrutinised to understand the impact on ethnic minority staff.
Then we come, my Lady, to trust, cultural competencies and engagement. If I can just touch upon each of these very briefly. A critical shortcoming of the test, trace and isolate strategy during the pandemic was its lack of cultural competency approaches. Ethnic minority communities faced significant barriers due to the failure of the government to provide TTI information in multiple languages, the use of culturally insensitive testing practices. These issues not only alienated non-English-speaking members of the community but also effectuated mistrust in community public health initiatives.
The absence of multilingual TTI materials meant that crucial information about testing, tracing and isolation measures was inaccessible to many ethnic minority individuals who did not speak English fluently, and this linguistic barrier hindered an ability to understand and adhere to guidelines effectively. Moreover, my Lady, culturally insensitive testing practices, such as disregarding religious or cultural practices during the testing procedures, created further barriers and deterred participation in the TTI system.
My Lady, I’m conscious of time. Can I just touch upon a couple of other points and then come on to some specific measures.
Can I turn to data transparency and usage. Data deficiency. What we say and what we would like this module to look at is lack of robust data on race and ethnicity within the TTI system, which we believe hindered efforts to address disparities. Comprehensive and disaggregated data is essential to accurately assess and reach the effectiveness of the TTI strategy among ethnic minority communities.
Then there are data privacy concerns. The absence of transparent data reporting, particularly regarding the Covid-19 app, eroded trust and compliance within certain communities, ethnic minority communities. Clear and consistent information about data privacy and protection measures is crucial, we say, for building trust.
Now I’m going to touch upon a few FEMHO client-specific measures which I’ve already shared with your counsel, but just for transparency.
So, vulnerable NHS staff criteria. We seek clarity on the criteria for vulnerable NHS staff reviewed by SAGE, especially concerning the high mortality rates among ethnic minority staff.
Secondly, policy influence. We say it’s troubling that the phenomenon of ethnic minority staff dying in greater numbers did not inform or influence national policy on TTI.
Then there’s the mobile app development. What became of the new mobile app for public deployment which was supposed to enhance contact tracing information and dissemination and system forecasting?
Behavioural nudges. What behavioural nudges were considered to support NHS middle and senior managers in promoting compliance among ethnic minority staff?
Testing distribution data. My Lady, we requested data on the distribution of tests across different hospitals and its correlation within the composition of ethnic minority staff.
Mental health support. What mental health and support services were specifically made available for, in particular, ethnic minority staff expected to isolate or shield? How were these services communicated and accessed?
Access to operational health services. How did the NHS ensure that minority staff were aware and had equal access to occupational health services during the pandemic, especially when isolated or shielding?
Handling complaints. How were complaints and feedback regarding discriminatory TTI practices handled? Was there any trend in complaints related to racism or bias in the provision of safety measures or symptomatic testing for ethnic staff? I’m nearly there, my Lady.
Health equality considerations. What considerations were given to existing health inequalities in minority communities when forming national TTI policies?
And finally on this, financial support disparities. Were there differences in financial support or compensation provided to families of ethnic minority healthcare workers who died from the virus compared to their white counterparts?
I’m not going to repeat what core participants for other bereaved families have said in relation to expert evidence or Rule 9. We do align ourselves with those submissions and you can see that from our written submissions. So we repeat those and I don’t repeat those here.
Let me just conclude by saying this: my Lady, it’s crucial to delve into the systemic shortcomings in the TTI strategy and understand how these failures perpetuated health disparities. Only by examining these issues, we say can the Inquiry uncover the root causes and develop more actionable recommendations going forward into the future.
Finally, FEMHO, my Lady, continues to be committed to contributing to our lived experiences and FEMHO members, you know, want to help this Inquiry with their professional expertise to aid this vital investigation.
I just want to clarify one thing that your counsel said this morning. When it comes to relying on our expertise, we hope that we can do that through evidence in the Inquiry and so I just want to make that – you know, FEMHO’s open to do that and our members are open should the Inquiry wish to have that assistance.
My Lady, unless I can be of any further assistance, those are my submissions.
Lady Hallett: Thank you, Mr Thomas. You got through a very great deal of important material in less than the allocated time; so thank you very much for your help. Thank you.
I think – is it Ms Peacock next? It is.
Submissions on Behalf of the Trades Union Congress by Ms Peacock
Ms Peacock: Thank you, my Lady, and good afternoon.
I appear on behalf of the Trades Union Congress, led by Sam Jacobs and instructed by Thompsons Solicitors.
The TUC brings together over 5 million working people who make up its 48 member unions. In this module, the TUC is working in partnership with TUC Cymru, the Scottish TUC, and the Northern Ireland Committee of the Irish Congress of Trades Unions.
Given the broad representation of the TUC’s affiliated unions across a diverse range of sectors and the importance of test, trace and isolate systems for those who continued to work throughout the pandemic, the TUC, its sister organisations, affiliated unions and the union members all have a vested interest in this module.
The alarming statistics on the systems of TTI in the UK speak for themselves. For example, Cabinet Office polling in January 2021 suggested that only 36 per cent of people with symptoms were being tested for Covid-19. A SPI-B paper in September 2020 reported that current rates of self-isolation are very low, less than 20 per cent based on self-report. They are particularly low among the youngest and the poorest.
Despite being alarming, these statistics do present an opportunity, we say. TTI was an area where, as other core participants have emphasised, the UK underperformed. Evidence from other countries (such as South Korea, Germany, Australia and the United States) suggest that much better outcomes can be achieved through successful systems of TTI. This is therefore an area where carefully considered, evidence-based recommendations could and should make a real meaningful difference in future outbreaks of infectious disease.
A particular focus for the TUC throughout the life of this Inquiry has been the financial support which was available to those in work to self-isolate when required to do so. A lack of adequate and accessible financial support for self-isolation has the capacity to undermine all other aspects of the TTI system. Somewhat unexpectedly, Dominic Cummings’ words on the topic cut straight through to the central, thorny issue. He said in oral evidence in Module 2:
“If I had very little money and I was told, ‘Well, you’ve got to stay at home’ but in doing that I wouldn’t have the cash to actually look after my own family, then obviously I’m going to ignore a lot of rules. I’m going to work and try and keep getting paid and that was the fundamental problem.”
During the pandemic that dilemma, comply with testing and isolation requirements or put food on the table, was the stark reality for many within the increasing population who are in work and in poverty in the UK.
Evidently where a person feels they cannot afford to self-isolate if they are required to do so, they are less likely to engage with the systems of testing and tracing which may result in them being asked to stay at home and out of work. Getting the provision of financial support right is therefore critical to the success of the entire TTI strategy. Given the disproportionate representation of people of colour, women, and people with disabilities and caring responsibilities within low paid and insecure work, it is also essential to ameliorating the uneven impacts of any mass outbreak.
The topic of financial support for self-isolation has been explored at high level in Module 2, with a focus on the decision-making by key government figures. In Module 7, we look forward to the opportunity to explore this topic in more detail and with a focus on there evidential basis for decisions, the efficacy of the policies and schemes which were devised, and recommendations regarding how this issue may be best addressed in future.
In general terms, the TUC welcomes the provisional outline of scope as being sufficiently broad. As Counsel to the Inquiry noted in her opening remarks, we do not invite amendment to it. However, we do make clear that the TUC’s view is that in order to properly assess the issues contained within the provisional scope, the Inquiry must scrutinise not only whether financial support was available, and in what amount, but also how it was administered. It’s one thing to set up a scheme to financially support low income workers but if workers are not aware of the scheme, or have heard that most applications are rejected, or know that applications often take weeks to process, they will not apply.
Therefore, financial support available via a pre-existing mechanism, such as statutory sick pay, may be very different in effect to an amount made available by a fragmented fund with a novel application process administered by individual local authorities. It is, therefore, both the availability of financial support and the means by which financial support is made available and communicated to the public that we say is crucial.
In our written submissions, we made two requests for clarification in respect of the provisional outline of scope. We are grateful to Counsel to the Inquiry for her indication that the Module 7 team will continue to co-ordinate closely with future modules on the financial support which was available, including in respect of the Adult Social Care Infection Prevention and Control Fund, and that Module 7 will request and explore evidence of the impact of TTI on a range of groups and populations, including key workers, those from minoritised and marginalised communities and those on low incomes.
In respect of expert evidence, we welcome Counsel to the Inquiry’s relation that experts instructed will have regard to relevant international comparisons. In previous modules, witness and documentary evidence has indicated that other countries performed better than the UK in systems of TTI. By way of example, Professor Anthony Costello stated in oral evidence in Module 2:
“If you get the support right, as later happened in New York, when they were given generous support for self-isolation, you got 94% compliance, whereas in this country many poor people did not comply with self-isolation simply because they couldn’t afford to do so …”
A briefing paper for a Covid-O meeting which took place on 22 January 2021 stated:
“Nearly all countries that have been successful in containing or eliminating the virus provide generous financial packages to their citizens who must self-isolate, whether through income guarantees, sick pay or targeted payments.”
In that Covid-O meeting, it was noted that self-isolation as a disincentive to get tested had been observed in the poorer boroughs of London where disease prevalence was high. This was no coincidence.
The evidence clearly exists in relation to the performance of TTI systems in other countries. The topic is, however, complex and technical. International comparative analysis by an expert will be more consistent and reliable. It could take account of variables in the way the data are collected and could provide recommendations rooted in the experience of other countries. We consider that such analysis would be of great value to this module.
We further support the submissions of the Federation of Ethnic Minority Healthcare Organisations, which Counsel to the Inquiry has touched upon this morning, on expert evidence.
An expert report from a specialist on race inequality will provide the Inquiry with the evidential basis for findings and recommendations which will serve minoritised communities and ensure that the failure of the response to the Covid-19 pandemic, the creation of a TTI system which should not break down barriers for people of colour but created and reinforced them, is not repeat in future.
In our written submissions, we set out a list of witnesses whose evidence we consider would assist this module, as well as identifying two specific areas we consider merit investigation via the evidence-gathering process. We welcome Counsel to the Inquiry’s liquidation that the Inquiry legal team has already started to consider our proposals on who ought to receive Rule 9s.
We note that one specific request made at paragraph 14 of our written submissions, regarding a supplementary witness statement from Dr David Halpern, has been addressed in email correspondence with the Inquiry team and we now have the INQ number for that statement which is 000391415.
We also made a series of observations regarding the proposed key lines of enquiry for Every Story Matters. We stand behind those submissions but we do not repeat them here.
We do, however, seek to emphasise one of those points and to make a wider point about its general relevance to this module. In our written submissions, we expressed that the potential audience groups for research conducted for Module 7 should include a further category; namely, workers in the manufacturing sector. Workers in the manufacturing sector are disproportionately in insecure work. Many are engaged on zero hours contracts, do not have the benefit of company sick pay, and wield little power over their working terms and conditions.
Throughout the pandemic, factories were the site of significant outbreaks of infection. For example, two workers died and 100 workers tested positive amid an outbreak at a branch of Bakkavor, a food manufacturing company which supplies Marks & Spencer. It was only after interventions by GMB, the union representing Bakkavor workers that the factory introduced a mass testing programme and full sick pay for workers required to self-isolate.
A member of the Bakers Food and Allied Workers union and a worker at a soft drinks factory, in response to a TUC survey, stated:
“No practical social distancing. We were provided with masks but not until around 22 per cent of the workplace tested positive for Covid. People who felt unwell with symptoms were allowed to stay on site or management left it up to the individual. Not getting paid while off, people stayed.”
The TUC welcomes the Inquiry’s intention, as is highlighted by the key lines of enquiry, to consider TTI within the healthcare sector. That is important. As we set out in our written submissions, we consider that social care workers should be included within the research audience groups.
We have had the opportunity to read the submissions of the Department for Education regarding inclusion of workers in the education sector and we support those submissions. In addition, the TUC urges the Inquiry to specifically investigate TTI in the manufacturing sector. This is especially important, given that workers in this sector do not have a dedicated module which will consider their circumstances.
Data from the Office of National Statistics reflect that process, plant and machine operatives were one of the occupational groups with the highest rates of death from Covid-19. The numerous outbreaks and disproportionate mortality within the sector are said to take careful consideration by this Inquiry.
Thank you, my Lady. Those are the submissions of the TUC. We stand ready to assist.
Lady Hallett: Thank you, Ms Peacock. Whether you will ever live down that, representing the TUC, you commented Mr Cummings – thank you very much.
Ms Peacock: We feel his point was a very strong one.
Lady Hallett: Last we have Mr Rogers.
Submissions on Behalf of the Welsh Government by Mr Rogers
Mr Rogers: My Lady, prynhawn Da. The Welsh Government is grateful for the opportunity to participate in Module 7 and to make these brief oral submissions. They supplement to the submissions already filed.
As in all other modules, the Welsh Government offers its full co-operation and support for your Inquiry’s work in examining the test, trace and isolate system known in Wales as “Test, Trace, Protect”. The Test, Trace, Protect programme in Wales was developed through partnership arrangements with the local health boards, Public Health Wales, local authorities and the third sector.
It formed a critical part of the wider response to the virus, as set out in the Welsh Government’s Coronavirus Control Plan for Wales. The scale and challenge of the pandemic brought these organisations in Wales together with a common goal of limiting the spread of the virus and protecting the population of Wales. Additionally, the Test, Trace, Protect programme in Wales involved working with the UK Government and the other devolved governments, an example of which is the National Testing Programme which formed an important part of the “test” element of Test, Trace, Protect in Wales.
My Lady, the Welsh Government is reassured that reports from the Inquiry’s listening exercise will inform the Inquiry’s investigations in Module 7. The Inquiry’s approach aligns with the Welsh Government’s determination that we listen to people from different communities and different backgrounds, particularly those who may have experienced difficulties in engaging with the test, trace and isolate systems operating throughout the UK.
We are greatly heartened by your assurances that the Inquiry will ensure that the voices of each devolved nation are clearly heard. We would urge that the voices of Welsh language speakers are also included in that consideration.
It is entirely right that Module 7 should closely examine both the experiences of and impact on individuals, as well as the broad range of decisions that were taken by the Welsh Government and by others in relation to the Test, Trace, Protect system in Wales.
The Welsh Government emphasises that it fully recognises the importance of that scrutiny. Indeed, it welcomes it. It is through such scrutiny that lessons may be learnt for the future for the benefit of all. The Welsh Government is therefore committed to providing every assistance that it can to the Inquiry to allow for its investigation to take place.
My Lady, diolch. Thank you.
Lady Hallett: Thank you very much, Mr Rogers.
Anything by way of response, Ms Cartwright?
Response by SENIOR COUNSEL TO THE INQUIRY
Ms Cartwright: My Lady, very briefly. You have heard helpful submissions that cover a wide range of topics in the course of this hearing and I know you, my Lady, and the Inquiry team will want to consider these with great care.
Can I thank all core participants and their legal representatives for their collaboration with the Module 7 team in advance of and today. That thanks is also extended to many other individuals and organisations who have been assisting the Module 7 investigation and the Module 7 team.
My Lady, I do not propose to address you further in respect of the detail of the oral submissions, unless there is any matter that you would wish me to address you specifically on.
Lady Hallett: Thank you very much. Thank you,
Ms Cartwright.
My thanks earlier to each of the speakers weren’t
simply a nod to courtesy. I genuinely am grateful to
everybody who has submitted both written submissions and
made oral submissions today. You’ve given me a great
deal of food for thought, as ever, and, as Ms Cartwright
says, I shall consider your submissions with care with
the Inquiry team and you’ll hear my response as soon as
we can get it out.
Thank you all very much indeed.
(1.01 pm)
(The hearing concluded)