2. Submission by Ms Munroe, KC

Ms Munroe: Good morning, my Lady, and thank you for the opportunity to make some further oral submissions to the written submissions that have been filed on behalf of Covid-19 Bereaved Families for Justice and Northern Ireland Covid-19 Bereaved Families for Justice.

They are detailed submissions, my Lady, and I am aware that we have a very full room and we have a lot of speakers today, and we are very aware – and I am very aware – of the constraints of time.

What I hope to do in making these oral submissions, my Lady, is to offer some constructive ideas and thoughts which we hope will enhance the Inquiry both in terms of its investigative process but also outcomes and recommendations. Because whatever position people in this room have, I think we all agree that this is an opportunity that should be grappled with and grasped with both hands so that the outcomes and recommendations are fulsome, are effective and that they are heard.

This was a pandemic that affected every strata in society. It was no respecter of class, race, gender, economic power, or anything. It therefore is important that the recommendations and outcomes are ones that are taken seriously and it is for that reason, my Lady, that we in our detailed submissions offer, as I say, I hope, constructive ideas and thoughts.

Any matters that I do not emphasise in oral submissions now it is not because we resile from them or that we think they are no longer important but, as I say, my Lady, I am mindful of the time and I seek, therefore, to highlight perhaps the most pressing matters which require some expansion in oral submissions.

Perhaps a thread that runs through all our submissions that we make is the issue of effective participation and ensuring that voices of the bereaved are heard and that they are heard by the right people and that they are acted upon.

Whilst of course our families welcome and are moved by commemorations and the Listening Exercises, expressions of sympathy, there also has to be a recognition that effective participation is key, that the families should not feel disconnected or that they are bystanders to what is going on and that experts speak on their behalf and their own lived experiences are perhaps not heard.

So it is with that in mind, my Lady, that we do revisit, and we set it out in our document, some of the matters that have been already submitted in Module 1 submissions before the Inquiry. In particular I will highlight the Rule 9 point, as it was one of the last matters that was dealt with on behalf of counsel to the Inquiry.

We repeat our concerns about the lack of disclosure of Rule 9s, which we say impedes our ability to assist the Inquiry. We don’t seek this disclosure for the sake of seeking disclosure. As I say, it is because of the need and the desire to assist the Inquiry. We hear what is said by counsel to the Inquiry but we believe that it will serve a very practical purpose. It may not be required in strict accordance with the Rules but we want to work in partnership with the Inquiry team.

This Inquiry is a mammoth task. No one team can or should be expected to have all the answers on how best to proceed. Collaboration and co-operation is key. As I said earlier, my Lady, it will lead to better outcomes and, importantly, our families will feel that they are in fact being heard and seen as an essential part of this Inquiry.

We therefore remain concerned that, in the absence of disclosure of the Rule 9 requests themselves, we are unable to assist the Inquiry with relevant lines of investigation that may be pursued. So we renew that request.

Rule 10s, my Lady, again we note the observations following the Module 1 hearing and the concessions that were made in respect of questioning of witnesses. In relation to Module 3, we submit that facilitating CPs’ questioning ensures, again, effective participation of the bereaved and others. This is central to their confidence in the Inquiry, cathartic, and forms some sort of resolution.

Full and effective participation on their behalf, we say, will engender wider public confidence as well.

If modules have limited direct evidence from CPs of their lived experience, questioning is the next best thing. It will allow and ensure a greater diversity of questioners and that will be beneficial to the Inquiry, but also questions from different CPs will, of course, be coming from different perspectives, and they may, in fact almost inevitably will, elicit different answers.

That is also something that can be extremely beneficial to the Inquiry.

My Lady, there’s always a concern if one allows CPs and their advocates to ask questions there will be a proliferation of issues, matters will be expanded, time will be expanded. However, I am certain, and on behalf of those that I represent we are certain, that with the strict case management that I am sure you will bring to bear on proceedings, permitting questioning in and of itself will not lead to those worries of expansion and time being expanded. Questions will be focused and relevant to the instructions and issues relevant to the particular CPs.

The Listening Exercise. What I say in relation to that, my Lady, is this. The companies and delivery of the listening exercise process and the issue of conflict of interest, again we revisit that simply to say this: fairness and the perception of fairness and transparency is important. There should be, we say, a proper public explanation from both the Inquiry and the companies involved as to why they say there is no conflict of interest. We note that even if there is no conflict of interest, the involvement of such companies may potentially do real damage to the whole project because of the perceptions of the families and others and that is then compounded by the lack of disclosure of precisely what these companies have been contracted to do and the results.

So really, my Lady, it’s a question, as I said, of perceptions, fairness and transparency.

I now turn to the issue of discrimination and racism. We have already addressed those previously in the Module 1 submissions. I hear both what is said by counsel to the Inquiry and, my Lady, your helpful remarks this morning in opening this session. But it is important that we do revisit this issue.

It is a hallmark of any society in terms of how it functions and what kind of society we live in how it treats its most disadvantaged, vulnerable and marginalised members and communities. It is vital to acknowledge that and it is vital, as I said earlier, to acknowledge that whilst the pandemic did affect every strata of society, regardless of race, class, socio-economic background, gender, physical or mental vulnerability or disability, nonetheless certain groups were differently and disproportionately affected.

It is said by the Counsel to the Inquiry that this matter, this issue of discrimination and structural racism, is at the forefront of its mind, however it is unnecessary and not proportionate.

We have to say that those words do not necessarily fill our clients with a great deal of confidence. Why is it not necessary? Why is it disproportionate? We say it is important. Inequalities and discrimination affect those who are affected by it in every aspect of their lives, maybe on a micro level, maybe on a macro level. Sometimes, it’s an irritant or a situation they can deal with. Sometimes it is a matter of life and death. It is therefore vitally important.

This module specifically looks at the impact of inequalities on healthcare staff. We say it is important that the topic also considers and looks at the ethnic background of NHS patients and their families who were impacted by the pandemic.

Structural racism exists. We are not asking the Inquiry to examine it as an abstract concept and embark upon a detailed investigation as to what is structural racism. It exists. It is the uncomfortable truth that we have to grapple with. It is not something that can or should be considered in isolation or in silos. It intersects and impacts, we say, on all modules.

We therefore say that the issue of structural discrimination and racism should be investigated as a key issue in each and every module.

If the Inquiry and if this Inquiry, my Lady, is to properly investigate the issue of systemic failings and failures, particularly looking at this module, not to consider structural discrimination would be a glaring omission.

We had set out in, I think it was, paragraph 14 of our Module 1 submissions, dated in January of this year, detailed submissions on this point and I don’t wish to repeat them all again here. But we say this: structural racism is not a new concept and, in the context of this public inquiry, structural racism has hitherto been recognised by many of the institutions that we are dealing with, such as the NHS. We’ve set out in our written document for this hearing today, my Lady, an article, Occupational Medicine, volume 72, issue 2, from March of this year, in which the author looks at the issue of structural racism and how it affected BAME workers and their risk to Covid-19. So I won’t repeat that. It’s there.

But I will say this in addition. New ONS data outlining Covid-19 mortality rates by ethnicities shows that, despite the gap closing in recent months, almost all minority groups who died died disproportionately from Covid-19. From January 2020 to November 2022, the death rate is 3.1 times greater for Bangladeshi men than for white British men, following by Pakistani men, 2.3 times, black Caribbean men, 1.8 times. Meanwhile, the rate for Bangladeshi women is 2.4 times greater than that for white women, white British women, followed by Pakistani women, 2.1, gypsy and Irish traveller women, 1.8 times, and for black Caribbean women the mortality rate is 1.5 times greater than for white British women.

Those we represent, my Lady, call upon the Inquiry to look at this, to look at these disproportionate figures, those disproportionately affected by the pandemic, and centre that within the Inquiry.

We also raise concern that there are groups, including groups representing migrants and the gypsy and Roma traveller community, who are not represented as Core Participants and appear to have been somewhat siloed off from issues which deeply impacted their own communities.

It is argued that until we dismantle those factors which enabled the pandemic to be racialised in its impact, we cannot mitigate a similar outcome from any future crisis and crisis responses.

We therefore call upon the Inquiry to investigate structural racism as a key in every module; secondly, to instruct an expert in the field of structural racism to shed light on the state of the UK’s preparedness in the lead up to the pandemic; thirdly, to rethink the Listening Exercise and centre those most impacted in a supportive and accessible way to enable full trust and participation in the process; and, fourthly, to ensure that migrant groups, such as the gypsy and Roma traveller communities, are represented as Core Participants.

My Lady, I’m looking at the time so I’m moving on now to two further points. Firstly, in relation to matters that we are revisiting: experts. Again, it’s set out in full in our written document but we do reiterate our point about letters of instructions and why it is important to see those. The letter of instruction to any expert is a basis upon which that expert finds out what exactly he or she is being asked to do. It is important, obviously, why they are such important documents and we submit that it is both extremely helpful but also just good practice for other CPs to have sight of and some input into letters of instructions so that we can ensure that it is comprehensive, it covers all issues and all relevant matters. So again it is not simply out of curiosity that we make this request; it is, we say, to assist the Inquiry.

My Lady, you will see at paragraph 28 through to 31 of our submissions we raise the issue of devolved issues generally and we set out there our position. Those will be expanded upon by my colleagues from Northern Ireland in due course, so I will not tread on any toes and say anything further and will leave that for them to expand.

Finally then, turning to the scope of Module 3. My Lady, I again am very mindful of your opening observations about the module being an evolving module. What it will eventually look like may be very different to what it looks like now in terms of the framework and certain matters that are not there now may be there and others may be moved. We can completely understand that.

So where we set out from our paragraph 32 onwards in our document specifically addressing scope, again, these points that we raise, my Lady, are really to look at areas that perhaps the Inquiry would like to consider as being important and should be within Module 3, why we say they should be within Module 3, and certain questions that we say they can answer. I certainly don’t have the time but without going through each at every one of them, for example, at paragraph 32 where we talk about therapeutics, we simply posit the question that it is unclear whether therapeutics are within the scope of Module 3 or not. So we put that out there effectively as a question for consideration.

There are other aspects of our discussion on scope (such as testing) however, where we have set out at paragraph 36 a set of questions that we say in our submissions the Inquiry should be investigating in relation to testing. Again, I won’t repeat them here because they are there in writing. But you can see, my Lady, I hope, why we say those particular questions would be relevant and germane to the investigation.

Likewise, with inspection and monitoring, in particular at paragraph 39, we say that in the absence of inspectors on the ground the Inquiry should consider what alternative arrangements were put in place and whether any interim provisions effectively monitored hospitals’ compliance with guidelines, shared emerging best practice on infection prevention and control, and made rapid recommendations for hospitals with high numbers of hospital-acquired infections to take corrective actions.

Again, that is the context in which we are putting forward these suggestions. Triage likewise, ventilation. Some of the others, such as patient vulnerability, other CPs specifically will be dealing with those, and I simply say on our behalf that we would add and complement those submissions.

On the issue of mental health in particular, we are very clear, my Lady, that certainly our clients feel that the scope of Module 3 should look at the adequacy and effectiveness of the NHS mental health services, not just to staff obviously, but also to those people affected by the pandemic itself. It is important, we say, to not having a narrow focus on that because mental health is an issue that is almost like a ripple effect; it starts with one person in the family, it affects other members of the family, other members of the community. So we ask that the Inquiry is mindful of that and it would seem to us that Module 3 would be the best place for such an investigation to take place.

My Lady, I suspect my time is now coming to an end so I simply would commend to you our written document. I hope that the submissions I have made have been, as I said at the outset, suggestive of constructive ideas and thoughts that we believe will assist the Inquiry. It will allow those we represent to feel fully participants in this Inquiry.

The phrase “front and centre” is often used about the bereaved and it is easy to say that; it’s more difficult to actually effect it. We know that the Inquiry and we know, my Lady, that you are mindful of these points. It is something that you have said on a number of occasions, and we are extremely grateful for those, but we do wish the Inquiry really seriously consider these submissions that are made and consider the points, particularly in respect of structural racism and how it overarches this Inquiry in its entirety.

My Lady, unless I can be of any further assistance to the Inquiry.

Lady Hallett: Ms Monroe, you have been extremely helpful. Excellent timekeeping, which bodes well for the future. Thank you very much indeed.

Just in case anybody is concerned, the written submissions that you and the rest of your team submitted are very comprehensive and I assure you that I will read them all extremely carefully. Thank you for your very constructive approach. Thank you.

I think it is only fair to the stenographer to break now.

Sorry, Mr – I thought that was Mr Lavery, wasn’t it? Yes, I was going to say, I think it is Mr McCaffery next. Is it? Anyway, whoever it is, we can work it out while we take a break and I shall return at 11.55. Thank you.

(11.36 am)

Lady Hallett: (A short break).

(11.57 am)

Lady Hallett: Mr Lavery, I apologise, I hadn’t realised you were next. While you are making your way to the lectern, could I apologise to the National Pharmacy Association – Mr Stanton, I don’t know where you are – I fear that when Ms Carey read out the list of Core Participants she forgot – I did notice at the time, I promise you. I didn’t want to interrupt her flow. But I’m sorry about that and I know Ms Carey’s already apologised to me for having missed you out. But we will be sure the transcript is amended so that the National Pharmacy Association appears there.

Yes, Mr Lavery. Sorry to –

Mr Lavery: In fact, my Lady, Mr McCaffery was next but he has kindly head to swap with me.

Lady Hallett: That’s what the confusion was.