3. Submissions on Behalf of the Department of Health and Social Care by Ms Scolding KC

Ms Scolding: Good morning, my Lady. I appear together with Mr Stein KC and we represent the Department of Health and Social Care in this Inquiry.

We wish to start by expressing our heartfelt condolences and deepest sympathies to all the families who have lost loved ones to this pandemic, had their lives disrupted and who have suffered the after-effects on both their mental and physical health.

The pandemic touched every family in the nation, and in many cases brought change, losses or absences which can never be fully repaired. The department recognises that the guidance it put in place often meant that family and friends were unable to see their loved ones for long periods of time, causing profound loneliness, pain and anguish, the effects of which still endure for many today and were so powerfully reminded to us by the accounts given in the video yesterday.

In particular, people were unable to visit and comfort loved ones who were unwell or dying, and were unable to undertake the important rituals surrounding death which are so vital for catharsis and expressing a shared grief. Not being able to attend and say goodbye at a family funeral was a nightmare for so many of us. The stoicism and forbearance shown and the sacrifices made by so many will never be forgotten.

The department also wishes to thank each and every person working within its own staff, in health and social care, in hospitals, care homes and in the community, in public health bodies, in local government, in the armed forces, in charities and the voluntary sector, as well as the hundreds of thousands of family carers who sought to keep their loved ones safe at considerable cost to their own physical and mental health in very many cases. The dedication and compassion shown by these individuals at very short notice and the efforts they made to provide comfort and support were nothing short of heroic, and we salute them.

We must also thank each and every person who changed their behaviour to protect those who were most at risk of being affected by the pandemic. The advice the department gave and the measures it was required to recommend needed the consent of the population. Everyone who stayed at home, often to the detriment of their mental health, their financial health, their education and their personal and professional relationships, helped keep us all safer. Without this agreement, many more people would have lost their lives. The resilience, determination and swift response by the population made a tremendous difference. The aim of the department and those working in it was at all times to save lives, minimise serious illness and protect health and care. Particularly during the first six months of the pandemic, when less was known about the virus and its transmission, there was frequently a need to issue guidance or create policies where there were, in reality, no good options.

The department recognises the strength of feeling amongst some that certain of the decisions made by us were wrong. For example, some people feel that lockdown should have been introduced earlier and for longer. Others hold an opposite and contrary view. What the department was often faced with were a choice between a series of wholly unpalatable options, all of which were certain to have negative impacts on the citizens of the United Kingdom in one way or another. Decisions were often extremely finely balanced. Contrary decisions could rationally have been made, resulting in a very different set of outcomes. The department will not seek, during the course of this Inquiry, to say that it did everything right or that it would necessarily have made the same decisions today, in 2023, with the benefit of hindsight. We will, however, propose that it is necessary to recognise that the context of the time, particularly in respect of pandemic preparedness, was very different to what we know now, and would ask you, my Lady, not to impose what we shall call a retroscope upon decision-making.

Covid-19 has not gone away. The department and all of those providing health and social care in Britain are still fighting it, even though effective vaccines and treatments mean that its impact is very much reduced. There are new variants which require further work to be undertaken and people are still becoming ill, sometimes seriously. Those with clinical vulnerabilities are also leading more restricted lives in some cases. The after-effects of Covid are profound on the mental and physical health of the nation, as I’ve mentioned, and not least on those whose treatment may have been paused for other diseases and illnesses because of the pandemic.

The job of the department is to remain vigilant and to keep caring for those who require it.

I shall not, my Lady, be setting out a detailed framework of the Department of Health and Social Care, to which I have no doubt many people shall be relieved. Our role is predominantly to support ministers to help people lead more independent, healthier lives for longer. Its job is to set in place the framework so that our NHS can function and deliver exceptional healthcare to the population, and to provide care services for the most vulnerable in our society.

The organisational framework for delivering such is complex and dispersed amongst a large number of bodies in central government, in arm’s length bodies related to central government, in local government, in charitable, voluntary and for-profit organisations. At the time of the pandemic, for example, there were 152 local authorities, 213 hospital trusts, 191 clinical commissioning groups, 34,000 general practitioners, and around 25,800 registered adult social care establishments, by which I mean both domiciliary, ie non-residential, and residential services.

The demands on both health and social care services have increased greatly over the past 20 years, as people live longer and breakthroughs in treatment and technology enable those with disabilities to thrive in an ever broader range of activities. Seeking to manage and provide guidance, support, equipment, services and policies during the pandemic was a Herculean task and was the greatest challenge ever faced by the NHS and the adult social care sector.

You will hear the department referring to various documents as “battleplans” or “operations” precisely because it was an all-consuming period akin to a war, and mobilisation was required in every organisation in the United Kingdom and with every person.

We approach this Inquiry with humility. We know that there are valuable lessons to be learned. We are open-minded to learn what others say about our processes and procedures both before and during the pandemic and the decisions we took.

By the end of 2020, everyone was thoroughly sick of the word “unprecedented”, but that is the most accurate description of what happened. This module is dealing with the plans that were put in place in advance of that period of time. Before the pandemic started, they were regarded by various international bodies as world-leading. Some of those plans did help during the pandemic, and our evidence to this Inquiry points out where that is the case. An obvious example was the work which had been undertaken following the Ebola outbreak in 2015 to put additional money into vaccine research, and the setting up by the previous Chief Medical Officer, Dame Sally Davies, of the National Institute for Health and Care Research, which brought together and aided research funding, again enabling a vaccine to be developed quickly by the UK’s scientists. Operation Cygnus, which was the exercise you heard about yesterday, undertaken in 2016, about planning for a flu pandemic, was also instrumental as it allowed the United Kingdom to have draft legislation which was then easily adapted for use during 2020.

However, the department does wish to identify areas where, in particular, it has sought to learn from what went well and also what did not go well in respect of preparedness, to enable it to prepare better for future pandemics and other catastrophic risks to the nation’s health and well-being. These are best encapsulated by the following five issues.

First, we need a toolkit of capabilities which can adapt to deal with whatever public health risk emerges, rather than a fixed plan against specific threats or viruses. Plans are important, but they are only as good as the core capabilities upon which they are based. This is the case for all measures which need to be taken during pandemics. For example, the provision of scientific advice, research, surveillance and data; the development of vaccines, diagnostics, testing and therapeutics; the system of regulation of medicines and medical products; stockpiles of medicines, vaccines and other material, including PPE; the maintenance of manufacturing capacity for testing, therapeutics, PPE and other pieces of equipment and medicine which is sited within the United Kingdom; and a legislative framework to enable actions to be implemented swiftly. Areas where the UK has relative strengths performed well during this pandemic. Where there was weakness or fragility, the response was not as good.

Secondly, the underlying resilience of the health and social care system really matters, because a strong system of public health and social care is needed to fight future risks effectively. Indeed, a resilient system, limited health inequalities, and a generally healthy population will be more likely to be able to cope with shocks of any kind. Levels of core capacity for day-to-day health and care services which must be resilient need to include specialist laboratories which can be expanded to meet demand rapidly, NHS general, critical and intensive care beds, with bed occupancy levels at a sustainable level, and appropriate and safe staffing.

There is also a need for social care services both at home and in residential settings to maintain a high level of built-in resilience, for there to be a good pipeline of medical supplies and for a workforce with the experience and numbers to cope.

The underlying health of the population and health inequalities also matter in the ability of our country to respond to new health threats. For example, the increasing age profile, levels of obesity, smoking or pre-existing comorbidities.

Third, any pandemic planning must include the ability to surge and scale up quickly in the first few months. Planning for preparedness and response capability in the future must address areas which have to be prepared in advance, for example, stockpiles of antivirals, stockpiles of therapeutic measures, stockpiles of PPE, whilst we learn more about the disease and start to develop specific medical countermeasures.

Planning must also consider provision in areas where an immediate response is required, for example the ability to buy disease-specific vaccines or to establish large-scale trials very quickly. We need to consider how we cope in the first few months of a pandemic so that our resources can be mobilised effectively and scaled up to meet the country’s needs.

Fourth, diagnostic surge capacity was a particular weakness in the past pandemic. The initial scientific and technical responses by way of genomic sequencing of the virus and the development of the test was good, reflecting our exceptional scientific community’s hard work and collaboration. Our end position of being able to provide over 1 million tests a day was amongst the best in the world, but it was very difficult to scale up testing in the first stages of this pandemic to the number and speed required, and it was an area of significant weakness compared to our international competitors and comparators.

Fifth, pandemic preparedness in the future should take account of and be responsive to all five routes of transmission of communicable disease: respiratory, touch, oral, blood, or by vector, for example an insect.

Covid-19 and flu are both respiratory diseases. The last major pandemic within the UK was HIV, which was sexually transmitted and required a very different response, and unfortunately there is still no effective vaccine for it. We need, as Professor Van Tam infamously said, very many shots at the goal the next time round.

We must recognise that future pandemics will be unexpected and will present new challenges. We need to be prepared for the worst by maintaining the resources and core capabilities that underpin a resilient health and care system, and a healthy population, alongside contingency arrangements to scale up quickly.

The department recognises that the role of the government is not just to ensure that the UK is prepared, but also to assist other countries with pandemic preparation and support, including surveillance, therapeutics and vaccines, to limit the spread of future diseases. This is not entirely altruistic, but must be seen as part of the strategy to protect the United Kingdom.

Finally, the department is well aware that many will argue that extra resource in health and care is part of the answer to improved pandemic preparedness. It is this department’s role to advise on strategies and policies to help, as I have already said, people live more independent, healthier lives for longer, and to deliver health and social care support that they need in a way which is of the highest quality, efficient and cost-effective.

It is, however, the job of the government as a whole to make and implement decisions on the level of resourcing, balanced against competing demands from other departments. In this regard, fiscal and economic resilience will always be vital to the country’s ability to resource the needs of its citizens, both in ordinary life and in future crises of this nature.

In short, the department welcomes the work of this Inquiry, recognises its importance in shaping future preparedness, and in assessing the numerous decisions taken in meeting the demands of the Covid pandemic. The department is here to assist with the work of the Inquiry in whatever way we can, and the department is committed to making sure that this country is ready to face the challenges presented by any and all future diseases.

Thank you for listening.

Lady Hallett: Thank you very much indeed.

Mr Kinnier.