13. Submission by Mr Simblet, KC

Mr Simblet: My Lady, the Covid-19 airborne Transmission Alliance (CATA) thanks you for granting this application for Core Participant status in Module 3. CATA looks forward to assisting this Inquiry in pursuing an effective investigation, and to that end we’ve submitted comprehensive and what we hope are helpful written submissions.

We very much hope that those will be published on the Inquiry’s website and we hope others will read them.

I asked for 15 to 20 minutes or so to speak to the following six themes:

1. To introduce my clients to you and say a little about how they come before you as Core Participants in this Inquiry.

2. To highlight the centrality of our concerns about airborne transmission and underscore its importance in your investigation of the healthcare system.

3. To highlight the issue of inadequate reporting of events and relevant data collection for the healthcare system.

4. To make some comments about the impact on healthcare workers.

5. Suggest some approaches in this module as to how the Inquiry might proceed.

6. To reinforce what others have said, that you remain alert to the benefits of interim recommendations and recommending interim measures.

So, (1), who and what is CATA? Well, CATA is a voluntary and collaborative forum, or consortium, made up of professional, scientific and employee organisations and individual representatives from all across the UK.

It was formed in response to the UK Government’s failure to recognise and adequately respond to the airborne route of transmission of the Covid-19 virus. The central contention is that UK Government’s failure to recognise airborne transmission of Covid-19 in a timely manner put healthcare workers at significant risk of illness and death and caused other serious problems.

For instance, the lack of acceptance of the risk of airborne transmission led to policies, decisions and practices that deprived health workers of the correct respiratory protective equipment, or RPE, to protect them from infection.

Now, CATA, as an umbrella for 12 constituent bodies and several individual representatives, coincidentally and not intended to be symbolic, now 19 entities, comprises a large number, over 65,000 people. Its members include professional organisations, trade unions and healthcare charities. They provide a representative voice for a wide range of healthcare workers in both institutional and community settings. Its purpose is to ensure that its knowledge of the existing and developing scientific evidence basis for the aerosol transmission of SARS-CoV-2, as well as the lived experience of its members, was made available to this Inquiry.

I say something about airborne transmission and its importance for Module 3. A core submission is the importance of the Inquiry having the correct starting point. Prior to the pandemic, beta coronaviruses, including SARS, were recognised to be transmitted via the airborne route.

We therefore disagree with paragraph 5 of NHS England written submissions where they assert that in early 2020 little was known about the Novel Coronavirus, including – continuing – whether, how quickly or in what ways it could be transmitted. We say that’s wrong. We say there was already a lot known about these types of viruses, and importantly there was an appropriate protection and regulatory framework already in existence for tackling them.

So one important issue for your Inquiry is to investigate why there was deviation from these existing policies and procedures, and instead why there wasn’t effective implementation of the appropriate framework for response. As we say at paragraph 9 of our written submissions, the prolonged, mistaken focus on a droplet transmission route of Covid-19 misdirected all from proper and effective risk management, undermining both worker protection and measures to manage clinical risk.

Simply put, there was a failure to appreciate the contemporaneous existing science regarding the airborne transmission of Covid-19. There was significant error in seeing Covid-19 as being due to an entirely new virus and, consequently, inappropriate measures were taken to deal with the virus in healthcare and community settings.

So the Inquiry will need to investigate whether promotion of the idea that the virus was spread through droplet rather than airborne transmission might have been because of inadequate available PPE and we note and support the observations from others such as the British Medical Association, the TUC, FEMHO, that this is an important topic for you to consider.

Crucially, CATA submits there was insufficient transparency and inadequate oversight, and the Government was misdirected on scientific decision-making during the pandemic. For example, there was a lack of transparency on the scientific sources and basis for the decisions made. These include, again, the focus on droplet as opposed to airborne transmission, the decision to remove the high consequence infectious disease, or HCID, status of Covid-19, and the decision to downgrade protective equipment for healthcare workers from effective respiratory protection equipment to fluid repellent surgical masks.

Even more specifically, the role of the infection prevention and control cell was not previously identified in the governance of pandemic management and its membership and basis for deliberations are unclear.

Notwithstanding this, the IPC cell was deferred to in all matters of health and safety and transmission control in healthcare settings. So the result was that the Government public bodies and employers failed in legal and public duties to assure public health and safety, particularly in the context of healthcare.

(3), the topic of inadequate reporting and data collection. CATA has raised in paragraph 26 of its written submissions the problem of inadequate reporting of Covid-19 infections and deaths among healthcare workers. Such reports are required by the reporting of injuries, diseases and dangerous occurrence regulations 2013, or RIDDOR as they have already been referred to. There also appeared to have been almost a policy decision not to investigate Covid deaths at inquests.

So, as an example, Scottish health boards’ recently produced statistics appear to suggest that not one single healthcare worker of working age died of Covid between 2020 to 2022. Of course this is incredible in the true sense of the word.

Our submission is that these responses (a) severely undermined the base of data for infectivity in the pandemic; (b) created a gap in accurate public health modelling for case studies and general tracking disease; and (c) impacted on the entitlement of healthcare workers to industrial injuries disablement benefit.

CATA is keen for the Inquiry to make the RIDDOR issue a key part of its investigation and, importantly, explore the implications that such under-reporting might have had for workplace infectivity and our understanding of the death rate.

So (4), impact on healthcare workers. CATA encourages the Inquiry to take an expansive approach to investigating healthcare. This requires considering not just what went on in the institutional settings but also in community settings. Of course there was a direct personal impact of Covid on CATA members and their families. But that also – or the impact on them also obviously affected patients and their families. There are significant continuing issues for patient care and provision with ongoing effects. For example, there are children presenting with more complex communication needs as they did not have speech and language therapy and access to services at the height of the pandemic. This is referred to in our paragraph 28.

On this issue, CATA invites the Inquiry to explore why there’s not been a long-term illness or disability allocation made available to healthcare workers living with Long Covid similar to the death in service allocation for Covid-19 and, the issue just mentioned, what has been the impact on outcomes for patients who could not access services or treatment in a timely way.

5. I will make some submissions on a suggested approach to the Inquiry. You will see at paragraphs 29 to 30 of our written submissions that we have made some detailed and comprehensive suggestions. At paragraph 29 CATA identifies various lines of inquiry or issues, and I will come on to the list of issues in a moment, and 30, paragraph 30 of our submissions, identifies various questions that you may want to ask yourself.

We hope that those are focused and considered. I’m not going to read them out but I am going to ask you to reread those when drawing up the future scoping or definition of issues for the Inquiry.

This approach from CATA we submit is scientific and evidence-led. CATA considers it is necessary for the Inquiry to go where the evidence takes it rather than to confine itself and restrict itself by reference to an over-prescriptive list of issues.

There’s been submissions both from your counsel and the submissions of others about the benefits of a list of issues, and of course that will be a benefit if it brings focus to the Inquiry. But of course, a list of issues cannot be and must not be allowed to become a device that restricts the pursuit of necessary lines of any enquiry, and CATA is comforted by the observations of your counsel this morning that any list of issues will no doubt be refined.

Our consortium hopes to be able to provide medical and scientific expertise and informed analysis and insights through our suggested questions and through our suggested lines of enquiry. CATA also hopes and expects that the Inquiry will take a suitably robust and independent approach when identifying, for instance, dissenting voices amongst civil servants and advisers. It will be necessary to hear from some people who are whistleblowers and to protect those people.

CATA has also made submissions at paragraph 34 of its written submissions, which it can summarise orally here, to the effect that the Inquiry is correct to state in paragraph 57 of its counsel’s submissions that its selection of its own experts and witnesses will be the subject of discussion and submission. CATA will, by its very nature, be able to assist with this task and we will in due course expect to make informed, detailed and helpful submissions on how this might be done and who can help.

Interim recommendations. Finally, on interim recommendations, we refer you to what we put in our written submissions at paragraph 38. We recognise that many public inquiries have seen fit to make interim recommendations to address a continuing harm, and Covid-19 is still ongoing. It’s still causing infection. It’s still affecting lives, including through those suffering from Long Covid. So we welcome what was said this morning in relation to interim recommendations.

Finally, my Lady, we hope that this introduction, alongside what has already been said in our written submissions, will explain where we feel this important module in the Inquiry should go. We want to help.

I told the Inquiry would speak for 15 to 20 minutes or so. I have been speaking for I think 12. We hope the Inquiry will be able to rely on CATA and their representatives to inform its important work in an accurate and efficient way. So unless I can help any further, my Lady.

Lady Hallett: No, thank you very much, Mr Simblet. Very interesting, and your submissions from your lay clients were definitely focused and considered. I am very grateful.

Mr Simblet: Thank you, my Lady.

Lady Hallett: Thank you.

Right, Mr Beer, and then Mr Kinnier, you’ve been waiting so patiently – well, I hope you have!

Mr Beer.